Gastrointestinal Tract, Digestion, and Lupus

From nausea and flatulence to diarrhea and abdominal pains, gastrointestinal issues are often under-discussed, but they can be a tell-tale sign of health for people with lupus.

The gastrointestinal (GI) tract is in charge of processing food to extract nutrients and dispose of waste. The digestive process works like this:

The gastrointestinal tract begins with your mouth where food is masticated (chewed). After food is swallowed, it travels down the esophagus. This is the only part of the digestive process that is directly under control. The rest of the process is involuntary.

When the esophageal sphincter relaxes, food enters the stomach. The stomach secretes digestive enzymes and gastric acid to help digest the food. From there, the partially digested food, known as chyme, passes through the pyloric sphincter into the duodenum, which is the first part of the small intestine. The small intestine then takes over, mixing food with digestive juices from the liver, pancreas, and intestine while also absorbing nutrients into the bloodstream.

Digestive muscles continue to work and they push waste into the large intestine. Waste can include undigested parts of food, fluids, and older cells that line the GI tract. The large intestine absorbs the remaining nutrients and water then changes the remaining material into stool. The rectum, located at the lower end of the large intestine, stores the stool until it is excreted during a bowel movement.

Common Gastrointestinal Issues with Lupus

There are a lot of organs and muscles involved in the digestive process. For people with lupus, gastrointestinal issues sometimes occur that need proper diagnosis and treatment. Some symptoms occur as a result of medications taken for lupus while other gastrointestinal issues are related to the disease itself. Here, we will explore some of the most common issues.

NOTE: Always bring up concerns and new symptoms with your lupus treatment team

Common Esophageal Disorders

As stated above, the esophagus is the tube that connects the mouth and throat to the stomach. For people with lupus, it is common to experience inflammation of the esophagus. This can result in:

• Gas
• Heartburn
• Indigestion
• Acid reflux
  • Persistent acid reflux is known as gastroesophageal reflux disease (GERD)

The Johns Hopkins Lupus Center shares that over-the-counter antacids like Rolaids or Tums can be used to treat occasional heartburn or indigestion. However, if you are experiencing these symptoms for more than two weeks at a time, you should mention them to your doctor who may prescribe additional gastrointestinal tract medications.

Some tips for avoiding heartburn and indigestion include:

• Eating smaller meals
• Leaving a 2-3 hour gap between eating and bedtime
• Cutting down on coffee, caffeine, and alcohol
• Remaining upright after eating
• Cutting back on aspirin
• Avoiding common trigger foods like:
  • Carbonated drinks
  • Fried foods
  • Citrus drinks
  • Peppermint
  • Chocolate
  • Tomatoes

Medications and Gastrointestinal Tract Issues

Peptic ulcers are sores that develop on the inside of the stomach lining or on the inside of the duodenum (in the small intestine). The most common symptom is stomach pain.

Long-term use of NSAIDS (non-steroidal anti-inflammatory drugs) increase the risk of stomach damage. Unfortunately, these medications are common for people with lupus.

Additionally, digestive challenges are common side effects of NSAIDS and corticosteroids. The most common side effects are:

• Nausea
• Vomiting
• Diarrhea
• Constipation

A third common type of medication for people with lupus are immunosuppressants. These medications provide benefit by suppressing the function of the immune system, but this increases the body’s risk of infection. Infections of the gastrointestinal system can cause abdominal cramps, pain, diarrhea, and fever.

Even though these are known side effects of medications, always bring up side effects with your lupus treatment team. They can work with you to find dosing that works better for you.

Other Gastrointestinal Tract Concerns

Peritonitis

Peritonitis, a serious condition affecting the peritoneum, usually occurs due to infection. The peritoneum is the lining on the inside of the abdomen. Both infection and inflammation caused by lupus can lead to a build-up of fluids in the abdomen. This is fluid build-up is known as ascites. Ascites can be caused by a number of conditions, so your doctor may examine a fluid sample to determine the correct treatment. The symptoms to look for include:

• Severe abdominal pain
• Tenderness to touch of the stomach
• Fever
• Nausea
• Vomiting
• Constipation

Liver complications

The liver is the largest internal organ and it plays a crucial role in keeping digestion and removing toxins from the blood. Inflammation of the liver can lead to hepatic vasculitis — a condition that can cause clots limiting the blood flow to the liver.

Another potential liver complication is jaundice. This can lead to a yellowing of the skin and/or the whites of the eyes. The cause of jaundice is typically an obstruction of a bile duct.

Pancreatitis

Inflammation of the pancreas is known as pancreatitis. The pancreas is responsible for creating several hormones, including insulin, and secreting fluids to aid in the digestive process. Symptoms may include abdominal pain, nausea, and vomiting.

How to Avoid Feeling Overwhelmed

This all can seem a bit overwhelming. Inflammation and infection can truly wreck havoc on the gastrointestinal tract and it is scary to see a list of potentially serious complications. But, as you can see from the lists above, many of the symptoms are quite similar.

If you are experiencing pain or discomfort, bring it up with your doctor. There is no need to feel embarrassed or shy around these topics. Whatever you call it — stool, bowel movement, feces, poop, or any of the other descriptive names for it — going to the bathroom is a crucial part of healthy functioning.

Keeping a journal of your medications, symptoms, and bowel movements can help you monitor changes overtime and ensure that your gastrointestinal tract is functioning appropriately.

Remember: Trust your gut!