Gastrointestinal manifestations of systemic lupus erythematosus (SLE): A comprehensive literature review

Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by a broad spectrum of clinical manifestations, including gastrointestinal (GI) involvement. Although the joints, skin, and kidneys are most commonly affected, GI manifestations are frequently underrecognized despite their potential to significantly influence patient outcomes. Eleven major GI manifestations have been identified and described: oral ulcers, lupus enteritis (LE), lupus peritonitis (LP), mesenteric vasculitis, mesenteric thrombosis, protein-losing enteropathy (PLE), intestinal pseudo-obstruction (IPO), lupus pancreatitis, lupus hepatitis (LH), gastroesophageal reflux disease (GERD), and medication-related adverse effects. These manifestations may present with nonspecific symptoms, such as abdominal pain, diarrhea, vomiting, and weight loss, which often complicate timely diagnosis. Imaging modalities, particularly contrast-enhanced computed tomography, together with serological markers, including antinuclear antibodies (ANA) and complement levels, play a central role in diagnosis. Corticosteroids remain the cornerstone of treatment, whereas immunosuppressive agents and biologic therapies are reserved for refractory cases. Medication-induced GI adverse effects, particularly those associated with glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), and immunosuppressive agents such as azathioprine (AZA) and cyclophosphamide (CPA), also represent important contributors to GI pathology in patients with SLE. Gastrointestinal involvement in SLE is heterogeneous and may be severe. Increased awareness, early recognition, and individualized treatment strategies are essential for improving patient outcomes. Further research is required to establish standardized diagnostic criteria and therapeutic guidelines for GI manifestations in SLE.