5 Minute Poster Presentation ARA-NSW 2020 - 42nd Annual NSW Branch Meeting

The management of gastrointestinal manifestations of systemic lupus erythematosus in adults: a systematic review (#10)

Luke D Williamson 1 , Shereen Oon 2 3 , Mandana Nikpour 2 3
  1. Rheumatology, Westmead Hospital, Westmead, NSW, Australia
  2. Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia
  3. University of Melbourne, Melbourne, Victoria, Australia

Background:

Systemic lupus erythematosus (SLE) can affect any part of the gastrointestinal system. Gastrointestinal (GI) symptoms are common, reportedly occurring in up to 50% of patients with SLE1, although these are mostly attributable to medication side-effects and infections. However, GI manifestations SLE are less commonly recognised or described, with a reported cumulative prevalence of 3.8% to 18%2. GI manifestations of SLE can be severe and life-threatening. Therefore, appropriate evidence-based treatment is essential to improve prognosis.

Methods:

We performed a literature search of published studies using MEDLINE (via Ovid and Pubmed), EMBASE, and the Cochrane Library. We included studies published after 1990, in the English language, in adults with SLE. As there were very few high-quality studies on the GI manifestations of SLE, we included case reports in addition to case series, cohort studies, and controlled trials. We searched for GI manifestations of SLE including lupus enteritis, lupus colitis, lupus ileitis, intestinal pseudo-obstruction, mesenteric vasculitis, protein-losing enteropathy, Budd-Chiari syndrome, lupus hepatitis, acute pancreatitis, peritonitis, hepatic vasculitis, autoimmune liver disease, and serositis. We combined this search with therapies, including non-drug treatments. We excluded non-SLE related GI manifestations, paediatric patients, studies not in English, and studies published before 1990.

The main outcomes assessed are mortality, SLE disease severity scores, and organ-specific outcome measures. Regarding bias, studies without a control or comparison group were automatically considered as high risk of bias. These studies were critically appraised using the relevant Joanna Briggs checklists3.

Results:

The final results of this systematic review are pending and are planned to be presented at the annual ARA-NSW branch meeting.

Discussion:

In the preliminary analysis of results, there is a paucity of high-quality data to guide management for the GI manifestations of SLE. There is a significant need for further studies in this area.

  1. 1. Hoffman BI, Katz WA. The gastrointestinal manifestations of systemic lupus erythematosus: a review of the literature. Seminars in arthritis and rheumatism; 1980: WB Saunders; 1980. p. 237-47.
  2. 2. Chng HH, Tan BE, Teh CL, Lian TY. (2010) Major gastrointestinal manifestations in lupus patients in Asia: lupus enteritis, intestinal pseudo-obstruction, and protein-losing gastroenteropathy. Lupus. 19(12), 1404-13.
  3. 3. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. (2017) Chapter 7: Systematic reviews of etiology and risk. Joanna Briggs Institute Reviewer's Manual The Joanna Briggs Institute. 2019-05.