Intestinal Pseudo-Obstruction and Lupus

Systemic lupus erythematosus, or SLE, is the most common immunological disease and often strikes women in the prime of life. It can have a variety of manifestations including digestive disturbances. One of the most serious is a condition called chronic intestinal pseudo-obstruction. What is the relationship between intestinal pseudo-obstruction and lupus?

What is Intestinal Pseudo-Obstruction?

Intestinal pseudo-obstruction is a condition where the muscles in the walls of the intestines fail to contract properly. This slows down or even stops the movement of food through the digestive tract leading to symptoms that mimic an intestinal obstruction without the actual blockage. It causes abdominal distension, pain, vomiting, constipation and weight loss in people unfortunate enough to have it. Intestinal pseudo-obstruction has a variety of causes. Inactivity, use of narcotic medications and some neurological disorders are some of the most common causes.

Intestinal Pseudo-Obstruction and Lupus: What’s the Association?

It’s not uncommon for people with SLE to have digestive problems, and intestinal pseudo-obstruction has been described in some people with lupus, although it’s not common. In a few cases, it was the first sign that a patient had lupus. Fortunately, doctors are now more aware that lupus can cause intestinal disturbances such as pseudo-obstruction.

What Causes Intestinal Pseudo-Obstruction in People with Lupus?

Lupus is an autoimmune disease that can damage every organ system in the body. It can also attack blood vessels and cause them to become inflamed, including the blood vessels in the intestines. When this happens, proteinaceous deposits containing a “stiff” compound called fibrin forms on the smooth muscle of the intestines. This slows down the ability of the intestines to move food through the digestive tract leading to a “functional” obstruction without an actual blockage.

When a patient has symptoms like this, it’s always important to rule out an obstruction before assuming the symptoms are due to pseudo-obstruction since an actual obstruction will require surgery.

Treating Pseudo-Obstruction in Lupus

X-rays are important for ruling out an actual obstruction, but the diagnosis of intestinal pseudo-obstruction is made by doing gastric motility and emptying studies. These tests show how rapidly food is being emptied from the stomach and how quickly it moves through the intestines. Slow motility in the absence of an obstruction on x-ray usually confirms the diagnosis.

Treatment of intestinal pseudo-obstruction in people with lupus usually consists of nutritional support, I.V. steroids and, sometimes, the use of drugs that stimulate movement of food through the intestines. Some lupus patients with pseudo-obstruction require steroids long-term to keep the condition under control.

Intestinal Pseudo-Obstruction and Lupus: The Bottom Line?

Intestinal pseudo-obstruction is not the most common digestive disturbance in people with lupus, but it does occur. In some cases, it can be the presenting sign of the disease. Fortunately, the symptoms can usually be controlled with steroids and nutritional therapy.

References

Gut. 1998 July; 43(1): 117–122.

Medscape.com. “Intestinal Pseudo-Obstruction as a Presenting Manifestation of Lupus”.