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Gastrointestinal symptoms and problems are common in lupus patients and can significantly impact their quality of life. In this article, we will explore lupus stomach medications and strategies for managing GI symptoms effectively.
This blog on Gastrointestinal Symptoms and Lupus Stomach Medications was edited and contributed to by Donald Thomas, MD; author of “The Lupus Encyclopedia.” Parts of this blog post come from “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Health Care Providers, edition 2“
Gastrointestinal symptoms in lupus can vary widely and may include:
Lupus can cause inflammation in the abdominal area, leading to persistent or intermittent abdominal pain. Of course, lupus patients can develop abdominal pain for many reasons unrelated to lupus as well. These include medication side effects, ulcers, gall bladder problems, infections, and irritable bowel syndrome, to name a few. Many of the lupus problems that can cause the GI symptoms listed below can also cause abdominal pain.
Some lupus patients experience nausea and vomiting, which can be caused by the disease itself, as a side effect of medications, or due to many other conditions (for example, gall bladder problems, irritable bowel syndrome, ulcers, and even pregnancy). Nausea and vomiting (N/V) in SLE patients are most commonly due to medications.
N/V occurs in around 8% of SLE patients during lupus flares. It could be related to inflammation around the abdominal organs (peritonitis), inflammation of any GI tract organs, or even vasculitis (blood vessel inflammation). When due to SLE, it usually resolves after immunosuppressant (immunomodulatory) treatment, as discussed below.
Gastrointestinal inflammation can disrupt normal bowel function, leading to diarrhea or constipation. Diarrhea is most commonly due to medications (and addressed similarly as above) or infection. Difficulty absorbing nutrients from food (malabsorption) can also cause diarrhea (as in celiac disease). Protein-losing enteropathy is a rare lupus problem.
Lupus patients may experience symptoms like heartburn and acid reflux due to inflammation in the esophagus. It is very important to abide by the lifestyle changes listed below under “Lupus Stomach Medications.”
Gastrointestinal symptoms can reduce appetite and unintended weight loss. Weight loss can be due to lupus (lupus cachexia) when lupus is very active and causing a lot of systemic inflammation. However, doctors will also want to run tests to ensure other causes are not occurring, such as other GI disorders, thyroid disease, infection, depression, anxiety disorder, and cancer (just to name a few potential causes).
Medications can cause many GI symptoms in lupus patients (such as nausea, stomach pain, diarrhea, constipation, heartburn, acid reflux, and appetite loss, and weight loss). These problems typically begin soon after starting the medication, making it easy to identify. In this case, the medication should be stopped or the dosage decreased. But they can sometimes occur after someone has been on medication for a while. In that case, several medicines may need to be stopped and reintroduced one at a time to determine which one is causing the problem.
Abdominal pain, nausea, heartburn, and N/V can also be due to other problems not related to lupus inflammation. These potential problems include as ulcers, irritable bowel syndrome, gall bladder issues, pancreatic disease, urinary tract infections, and even pregnancy. Figuring out the cause of GI symptoms can be complicated, requiring many tests and the involvement of other specialists, such as gastroenterologists.
Managing gastrointestinal symptoms in lupus often involves a combination of medications and lifestyle modifications. Here are some medications commonly used to address lupus-related stomach issues:
Anti-reflux drugs are often considered if changing lifestyle habits or changing offending medications do not stop the symptoms. If symptoms are mild and intermittent, then over-the-counter preparations can be tried. These include Tums, Alka-Seltzer, Pepto Bismol, Mylanta, Rolaids, Prilosec, Pepcid Complete, and Tagamet. But check with your doctor before taking these. Some interact with other drugs or should not be used with some medical problems.
Your doctor may put you on anti-acid prescription medicine. This can help you feel better and prevent some GERD complications. For example, aluminum sucrose sulfate (Sucralfate) coats and protects the esophagus and stomach lining. It can help people with mild GERD, especially when problems occur after eating.
Other anti-GERD drugs typically lower stomach content acidity. Prescription-strength drugs that reduce stomach acid are divided into two main groups: proton pump inhibitors (PPIs) (table 28.3) and histamine type 2 (H2) blockers.
It’s important to note that individuals should consult a healthcare provider who specializes in lupus management to make informed choices about medications for lupus-related gastrointestinal symptoms. They will consider your individual symptoms, disease activity, and overall health when determining the most appropriate treatment plan.
Gastrointestinal symptoms can significantly impact the lives of lupus patients, but there are medications and lifestyle modifications available to help manage these symptoms effectively. If you have lupus and are experiencing stomach-related issues, consult with your healthcare provider to develop a personalized treatment plan that addresses your unique needs and improves your overall quality of life.
Read chapters 15 and 28 of The Lupus Encyclopedia, edition 2
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Read more in The Lupus Encyclopedia, edition 2
Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia
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