Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Gastrointestinal manifestations of systemic lupus erythematosus

Elena M Massarotti, MD
Section Editor
David S Pisetsky, MD, PhD
Deputy Editors
Monica Ramirez Curtis, MD, MPH
Shilpa Grover, MD, MPH, AGAF


Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown cause that can affect the skin, joints, kidneys, lungs, nervous system, serous membranes, and/or other organs of the body.

The gastrointestinal manifestations of SLE in adults will be reviewed here. An overview of other clinical manifestations as well as the treatment of SLE in adults are presented separately. (See "Overview of the clinical manifestations of systemic lupus erythematosus in adults" and "Overview of the management and prognosis of systemic lupus erythematosus in adults".)


Gastrointestinal involvement is common in patients with systemic lupus erythematosus (SLE), and up to 40 percent of patients have gastrointestinal manifestations during their lifetime [1-5]. These manifestations may be due to vasculitis, side-effects of the medications used to treat SLE, infection, or other intercurrent processes (eg, uremia).


Dysphagia is the most frequent gastrointestinal complaint in patients with systemic lupus erythematosus (SLE) and may occur in association with retrosternal chest pain, heartburn, regurgitation, or odynophagia. These symptoms may be due to an underlying esophageal motility disorder, concomitant gastroesophageal reflux disease, or other causes of esophagitis such as medication-induced esophagitis or Candida esophagitis.

Approximately 20 to 70 percent of patients with SLE have an underlying esophageal motility disorder [6-8]. Esophageal motility disorders do not appear to be associated with disease activity, duration, and treatment of SLE [9]. Although esophageal motility disorders have been associated with the Raynaud phenomenon and the presence of antiribonucleoprotein antibodies, it is unclear if this association is due to the presence of other connective tissue disorders [5]. The mechanism by which SLE leads to an esophageal motility disorder is not known. It may result from an inflammatory reaction in the esophageal muscles, or by ischemic or vasculitic changes to Auerbach's plexus [10,11]. (See "Esophageal motility disorders: Clinical manifestations, diagnosis, and management".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Sep 08, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Watts RA, Isenberg DA. Pancreatic disease in the autoimmune rheumatic disorders. Semin Arthritis Rheum 1989; 19:158.
  2. Hoffman BI, Katz WA. The gastrointestinal manifestations of systemic lupus erythematosus: a review of the literature. Semin Arthritis Rheum 1980; 9:237.
  3. Jovaisas A, Kraag G. Acute gastrointestinal manifestations of systemic lupus erythematosus. Can J Surg 1987; 30:185.
  4. Zizic TM, Classen JN, Stevens MB. Acute abdominal complications of systemic lupus erythematosus and polyarteritis nodosa. Am J Med 1982; 73:525.
  5. Sultan SM, Ioannou Y, Isenberg DA. A review of gastrointestinal manifestations of systemic lupus erythematosus. Rheumatology (Oxford) 1999; 38:917.
  6. Gutierrez F, Valenzuela JE, Ehresmann GR, et al. Esophageal dysfunction in patients with mixed connective tissue diseases and systemic lupus erythematosus. Dig Dis Sci 1982; 27:592.
  7. Ebert EC, Hagspiel KD. Gastrointestinal and hepatic manifestations of systemic lupus erythematosus. J Clin Gastroenterol 2011; 45:436.
  8. Castrucci G, Alimandi L, Fichera A, et al. [Changes in esophageal motility in patients with systemic lupus erythematosus: an esophago-manometric study]. Minerva Dietol Gastroenterol 1990; 36:3.
  9. Ramirez-Mata M, Reyes PA, Alarcon-Segovia D, Garza R. Esophageal motility in systemic lupus erythematosus. Am J Dig Dis 1974; 19:132.
  10. Saab S, Corr MP, Weisman MH. Corticosteroids and systemic lupus erythematosus pancreatitis: a case series. J Rheumatol 1998; 25:801.
  11. Ginzler EM, Aranow C. Prevention and treatment of adverse effects of corticosteroids in systemic lupus erythematosus. Baillieres Clin Rheumatol 1998; 12:495.
  12. Nadorra RL, Nakazato Y, Landing BH. Pathologic features of gastrointestinal tract lesions in childhood-onset systemic lupus erythematosus: study of 26 patients, with review of the literature. Pediatr Pathol 1987; 7:245.
  13. Luo JC, Chang FY, Chen TS, et al. Gastric mucosal injury in systemic lupus erythematosus patients receiving pulse methylprednisolone therapy. Br J Clin Pharmacol 2009; 68:252.
  14. Ceccato F, Salas A, Góngora V, et al. Chronic intestinal pseudo-obstruction in patients with systemic lupus erythematosus: report of four cases. Clin Rheumatol 2008; 27:399.
  15. Mok MY, Wong RW, Lau CS. Intestinal pseudo-obstruction in systemic lupus erythematosus: an uncommon but important clinical manifestation. Lupus 2000; 9:11.
  16. Park FD, Lee JK, Madduri GD, Ghosh P. Generalized megaviscera of lupus: refractory intestinal pseudo-obstruction, ureterohydronephrosis and megacholedochus. World J Gastroenterol 2009; 15:3555.
  17. Tian XP, Zhang X. Gastrointestinal involvement in systemic lupus erythematosus: insight into pathogenesis, diagnosis and treatment. World J Gastroenterol 2010; 16:2971.
  18. Law ST, Ma KM, Li KK. The clinical characteristics of lupus related protein-losing enteropathy in Hong Kong Chinese population: 10 years of experience from a regional hospital. Lupus 2012; 21:840.
  19. Mok CC, Ying KY, Mak A, et al. Outcome of protein-losing gastroenteropathy in systemic lupus erythematosus treated with prednisolone and azathioprine. Rheumatology (Oxford) 2006; 45:425.
  20. Zheng WJ, Tian XP, Li L, et al. Protein-losing enteropathy in systemic lupus erythematosus: analysis of the clinical features of fifteen patients. J Clin Rheumatol 2007; 13:313.
  21. Gornisiewicz M, Rodriguez M, Smith JK, et al. Protein-losing enteropathy in a young African-American woman with abdominal pain, diarrhea and hydronephrosis. Lupus 2001; 10:835.
  22. Perednia DA, Curosh NA. Lupus-associated protein-losing enteropathy. Arch Intern Med 1990; 150:1806.
  23. Runyon BA, LaBrecque DR, Anuras S. The spectrum of liver disease in systemic lupus erythematosus. Report of 33 histologically-proved cases and review of the literature. Am J Med 1980; 69:187.
  24. Matsumoto T, Yoshimine T, Shimouchi K, et al. The liver in systemic lupus erythematosus: pathologic analysis of 52 cases and review of Japanese Autopsy Registry Data. Hum Pathol 1992; 23:1151.
  25. Chowdhary VR, Crowson CS, Poterucha JJ, Moder KG. Liver involvement in systemic lupus erythematosus: case review of 40 patients. J Rheumatol 2008; 35:2159.
  26. Gibson T, Myers AR. Subclinical liver disease in systemic lupus erythematosus. J Rheumatol 1981; 8:752.
  27. Grover S, Rastogi A, Singh J, et al. Spectrum of Histomorphologic Findings in Liver in Patients with SLE: A Review. Hepat Res Treat 2014; 2014:562979.
  28. Hallegua DS, Venuturupalli S. Gastrointestinal and hepatic manifestations. In: Dubois' lupus erythematosus and related syndromes, 8, Wallace DJ, Hahn BH (Eds), Elsevier Saunders, Philadelphia 2013. p.420.
  29. Irving KS, Sen D, Tahir H, et al. A comparison of autoimmune liver disease in juvenile and adult populations with systemic lupus erythematosus-a retrospective review of cases. Rheumatology (Oxford) 2007; 46:1171.
  30. Efe C, Purnak T, Ozaslan E, et al. Autoimmune liver disease in patients with systemic lupus erythematosus: a retrospective analysis of 147 cases. Scand J Gastroenterol 2011; 46:732.
  31. Hallegua DS and Venuturupalli S. Gastrointestinal and hepatic manifestations. In: Dubois' lupus erythematosus and related syndromes, 8, Wallace DJ and Hahn BH (Ed), Elsevier, Philadelphia 2013. p.422.
  32. van Hoek B. The spectrum of liver disease in systemic lupus erythematosus. Neth J Med 1996; 48:244.
  33. Ohira H, Takiguchi J, Rai T, et al. High frequency of anti-ribosomal P antibody in patients with systemic lupus erythematosus-associated hepatitis. Hepatol Res 2004; 28:137.
  34. Reynolds JC, Inman RD, Kimberly RP, et al. Acute pancreatitis in systemic lupus erythematosus: report of twenty cases and a review of the literature. Medicine (Baltimore) 1982; 61:25.
  35. Pascual-Ramos V, Duarte-Rojo A, Villa AR, et al. Systemic lupus erythematosus as a cause and prognostic factor of acute pancreatitis. J Rheumatol 2004; 31:707.
  36. Nesher G, Breuer GS, Temprano K, et al. Lupus-associated pancreatitis. Semin Arthritis Rheum 2006; 35:260.
  37. Makol A, Petri M. Pancreatitis in systemic lupus erythematosus: frequency and associated factors - a review of the Hopkins Lupus Cohort. J Rheumatol 2010; 37:341.
  38. Shapeero LG, Myers A, Oberkircher PE, Miller WT. Acute reversible lupus vasculitis of the gastrointestinal tract. Radiology 1974; 112:569.
  39. Cervera R, Espinosa G, Cordero A, et al. Intestinal involvement secondary to the antiphospholipid syndrome (APS): clinical and immunologic characteristics of 97 patients: comparison of classic and catastrophic APS. Semin Arthritis Rheum 2007; 36:287.
  40. Ko SF, Lee TY, Cheng TT, et al. CT findings at lupus mesenteric vasculitis. Acta Radiol 1997; 38:115.
  41. Lee CK, Ahn MS, Lee EY, et al. Acute abdominal pain in systemic lupus erythematosus: focus on lupus enteritis (gastrointestinal vasculitis). Ann Rheum Dis 2002; 61:547.
  42. Hiraishi H, Konishi T, Ota S, et al. Massive gastrointestinal hemorrhage in systemic lupus erythematosus: successful treatment with corticosteroid pulse therapy. Am J Gastroenterol 1999; 94:3349.
  43. Pott Júnior H, Amate Neto A, Teixeira MA, Provenza JR. Ascites due to lupus peritonitis: a rare form of onset of systemic lupus erythematosus. Rev Bras Reumatol 2012; 52:116.
  44. Watanabe R, Fujii H, Kamogawa Y, et al. Chronic lupus peritonitis is characterized by the ascites with a large content of interleukin-6. Tohoku J Exp Med 2015; 235:289.
  45. Provenzano G, Rinaldi F, Le Moli S, Pagliaro L. Chronic lupus peritonitis responsive to treatment with cyclophosphamide. Br J Rheumatol 1993; 32:1116.