GERD and Peptic Ulcer Disease in Lupus

Gastroesophageal Reflux Disease and Peptic Ulcer Disease are common digestive problems that many people with systemic lupus erythematosus (SLE) experience. Although lupus does not usually directly cause these conditions, lupus medications and related health problems can increase the risk. Therefore, understanding the causes, symptoms, and treatments can help us protect our digestive health.

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In The Lupus Encyclopedia, Chapter 28 explains that digestive symptoms in lupus often relate to treatment effects rather than lupus itself. Understanding these connections helps us recognise symptoms early and discuss appropriate treatments with our healthcare providers.

“Gastroesophageal reflux disease (GERD) and stomach ulcers are usually not caused by lupus directly. Nonetheless, they are common in SLE patients and are often related to drug side effects.”

We can also learn more about other lupus-related health concerns in our guides to lupus symptoms and complications and lupus medications and side effects.

Understanding Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease, often called GERD or acid reflux, occurs when acidic stomach contents move backward into the esophagus. Normally, a circular muscle called the lower esophageal sphincter prevents this movement.

The sphincter opens when food travels from the esophagus into the stomach. After food enters the stomach, it tightens again. However, when this muscle does not close properly, stomach acid can travel upward and irritate the esophagus.

“GERD develops when the stomach’s acidic contents back up, or reflux, through this barrier and up into the esophagus.”

People with lupus may develop GERD for several reasons. For example, some medications used to treat lupus can relax the lower esophageal sphincter. Calcium channel blockers, which doctors often prescribe for Raynaud’s phenomenon, can contribute to reflux symptoms.

Moreover, several lifestyle factors can worsen GERD. Tobacco, alcohol, caffeine, chocolate, peppermint, and fatty foods can relax the sphincter or increase symptoms. Therefore, avoiding personal triggers can make a significant difference.

Why Lupus Can Increase GERD Risk

Several lupus-related factors can contribute to Gastroesophageal Reflux Disease. For example, some people with lupus also have Sjögren’s syndrome overlap, which can reduce saliva production.

Saliva normally helps move substances through the esophagus and into the stomach. However, when saliva production decreases, stomach contents may remain in the esophagus longer.

“About 30% to 50% of people with SLE have decreased saliva formation due to Sjögren’s overlap.”

A hiatal hernia can also increase GERD risk. This condition occurs when part of the stomach moves upward through the opening in the diaphragm. Consequently, the lower esophageal sphincter may not work correctly.

In addition, increased pressure around the abdomen can worsen reflux. Obesity, pregnancy, tight clothing, coughing, and bending over can all increase pressure on the stomach.

Common Symptoms of GERD

Heartburn remains the most common symptom of GERD. People often describe it as a burning sensation behind the breastbone. However, GERD can cause several other symptoms.

Common symptoms include:

• Heartburn
• Chest pain or discomfort
• Difficulty swallowing
• A lump-like feeling in the throat
• Nausea
• Increased saliva production
• Acid or food coming back into the mouth

GERD can sometimes create chest pain that feels similar to a heart attack. However, we should never assume chest pain comes from reflux without medical assessment.

“Heartburn can even cause chest pain that feels like a heart attack. However, never assume this on your own.”

This warning is especially important for people with lupus because cardiovascular disease remains a major health concern. Therefore, doctors should always evaluate unexplained chest pain.

GERD can also cause less obvious symptoms. For example, acid reaching the vocal cords can cause hoarseness. Acid entering the airway can contribute to coughing or asthma-like symptoms.

Potential GERD Complications

Untreated GERD can cause ongoing irritation and damage. The stomach has a protective lining that helps defend against acid, but the esophagus and airway do not have the same protection.

Over time, repeated acid exposure can cause inflammation called esophagitis. More serious complications can include ulcers, scarring, narrowing of the esophagus, and Barrett’s esophagus.

“Repeated exposure of the esophagus cells to acid can cause a precancerous condition called Barrett’s esophagitis.”

GERD can also affect the lungs. Acid entering the airway may cause persistent coughing, breathing problems, or worsening lung disease in people with lupus.

Therefore, people with lupus lung problems should discuss reflux symptoms with their healthcare team.

Treating Gastroesophageal Reflux Disease

Lifestyle changes are usually the first step in managing GERD. These changes can reduce symptoms and may reduce the need for medication.

Helpful steps include avoiding trigger foods, stopping smoking, reducing alcohol intake, maintaining a healthy weight, and avoiding lying down soon after eating.

However, some people need medication. Doctors may recommend antacids, H2 blockers, or proton pump inhibitors (PPIs).

“The first step in treating GERD is to change lifestyle habits that worsen it.”

PPIs reduce stomach acid production and often provide stronger symptom control than H2 blockers. However, long-term PPI use requires careful monitoring.

PPIs may affect vitamin B12 and magnesium levels. Therefore, people who use these medications for long periods should discuss appropriate monitoring with their doctor.

People who take mycophenolate mofetil (CellCept) should also discuss PPI use with their healthcare provider.

“PPIs can lower mycophenolate mofetil (CellCept) drug levels by around 35%, making it less effective for treating lupus.”

Understanding Peptic Ulcer Disease

Peptic Ulcer Disease occurs when stomach acid damages the lining of the stomach or small intestine. These ulcers can develop in the stomach or the duodenum, which is the first part of the small intestine.

Although lupus itself usually does not directly cause peptic ulcers, some lupus medications can increase risk.

“Peptic ulcer disease is a condition in which ulcers occur in the stomach or small intestine due to stomach acid.”

NSAIDs are one of the most common causes of ulcers in people with lupus. These medicines reduce pain and inflammation, but they can also reduce the stomach’s natural protection.

Steroids, aspirin, blood thinners, and some other medications can further increase ulcer risk.

Symptoms and Warning Signs of Peptic Ulcers

Peptic ulcers can cause burning, gnawing, or cramping pain in the upper abdomen. Some people also experience bloating, nausea, heartburn, or feeling full quickly after eating.

However, symptoms do not always appear. NSAID-related ulcers can develop without obvious warning signs.

“Most of the time (70% or higher), NSAID-induced ulcers do not cause pain.”

Because ulcers may remain unnoticed, complications can occur suddenly. These complications include bleeding, perforation, and intestinal blockage.

Warning signs of ulcer bleeding include vomiting material that looks like coffee grounds or passing black, tar-like stools. Therefore, these symptoms require urgent medical attention.

Diagnosing and Treating Peptic Ulcers

Doctors diagnose peptic ulcers using tests such as an upper endoscopy (EGD). This procedure allows doctors to view the digestive tract and collect tissue samples when needed.

Doctors may also test for Helicobacter pylori (H. pylori), a bacteria that can cause ulcers and increase stomach cancer risk.

“H. pylori is treated with a combination of antibiotics plus a PPI.”

Treatment depends on the cause of the ulcer. If NSAIDs caused the problem, doctors may recommend stopping them or adding protective medication.

People at higher risk of NSAID-related ulcers may benefit from preventive medicines such as PPIs or misoprostol. Therefore, discussing ulcer risk before starting long-term NSAIDs is important.

Protecting Digestive Health With Lupus

Gastroesophageal Reflux Disease and Peptic Ulcer Disease can affect many people living with lupus. However, recognising symptoms early and understanding medication risks can help us protect our digestive health.

By making lifestyle changes, reviewing medications, and seeking medical advice when symptoms appear, we can reduce complications. Moreover, working closely with our healthcare team helps us balance effective lupus treatment with digestive protection.

For more information about managing lupus, explore our resources on living with lupus and lupus treatment approaches.

For more in-depth information on digestive system:

Read chapter 28 of The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

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