Evaluation of abdominal pain in systemic lupus erythematosus

Abdominal pain is a common finding in patients with systemic lupus erythematosus (SLE), occurring in as many as half of all SLE patients in the course of their disease. The rheumatology and gastroenterology literature emphasizes etiologies of abdominal pain in patients with SLE such as peritonitis from polyserositis, dyspepsia from reflux, nausea and vomiting from bowel edema, ascites, mesenteric ischemia, pancreatitis, pneumatosis intestinalis from necrotizing enterocolitis, and hepatobiliary abnormalities. But in clinical practice, caring for SLE patients in a community teaching hospital, these seem to be rare entities.

A chart review study was performed of all patients with SLE with the diagnosis of abdominal pain admitted to a community teaching hospital between 1980 and 1995.

Of 13 patients who presented with abdominal pain, 9 required surgical intervention for cholecystitis, perforated ulcer, colonic perforation, diverticulitis, and adhesions. There were no negative laparotomies for polyserositis or bowel edema, or cases of mesenteric infarction or ascites.

Despite some unusual diagnostic possibilities in abdominal pain in SLE such as polyserositis and mesenteric infarction, and despite the superimposed problems of steroid therapy in most of the patients in this study, the majority of lupus patients with abdominal pain presenting at community hospitals have relatively conventional illnesses.