Systemic Lupus Erythematosus, commonly known as Lupus, is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. This widespread attack can impact various parts of the body, including the skin, joints, kidneys, and brain. Gastroesophageal Reflux Disease (GERD) is a digestive disorder characterized by the frequent backflow of stomach acid into the esophagus, the tube connecting the mouth to the stomach. Individuals with Lupus often experience a higher prevalence of GERD, indicating a connection between these conditions.
Understanding the Connection
Lupus can contribute to GERD through systemic inflammation, a hallmark of the autoimmune disease. This inflammation can directly affect the esophageal lining and the lower esophageal sphincter (LES), the muscle preventing stomach acid reflux. When the LES weakens or malfunctions, stomach contents can easily reflux, leading to persistent acid reflux and GERD.
Autoimmune damage to esophageal tissues can also occur. The immune system’s attack can impair esophageal muscular contractions, known as esophageal dysmotility. This impaired movement allows acid to linger or reflux, worsening GERD. Autoimmune involvement is a recognized factor.
Lupus medications can also influence GERD. Nonsteroidal anti-inflammatory drugs (NSAIDs), used for pain and inflammation, can irritate the digestive tract, causing heartburn, stomach ulcers, and bleeding. Corticosteroids, used to suppress the immune system, may also contribute to gastrointestinal upset and acid reflux.
Secondary conditions associated with Lupus can also impact GERD. Raynaud’s phenomenon, affecting blood flow, can cause esophageal motility issues contributing to reflux. Sjögren’s syndrome, an autoimmune condition sometimes co-occurring with Lupus, reduces saliva production and causes dry mouth. Reduced saliva, which neutralizes stomach acid, can worsen GERD symptoms.
Recognizing Symptoms
Individuals with Lupus who develop GERD may experience specific symptoms. Heartburn, a burning sensation in the chest, is common. Regurgitation, where stomach acid or food flows back into the mouth, often leaves an acidic taste.
Other symptoms include chest pain and difficulty swallowing (dysphagia). A persistent cough, especially one worsening at night or after eating, can also be a sign of GERD. These symptoms can overlap with other Lupus manifestations, making accurate diagnosis important.
Managing GERD with Lupus
Diagnosing GERD with Lupus involves a comprehensive evaluation by a healthcare provider. Diagnostic methods include upper endoscopy (visual inspection of esophagus and stomach lining) and pH monitoring (to measure acid levels). Esophageal manometry can also assess esophageal muscle function.
Management strategies for GERD often begin with lifestyle modifications. Avoiding trigger foods like spicy or fatty meals, chocolate, coffee, peppermint, and carbonated beverages can help. Eating smaller, more frequent meals, elevating the head of the bed, and avoiding lying down for two hours after eating are also beneficial. Maintaining a healthy weight and quitting smoking can further alleviate GERD.
Medications are also used to manage GERD symptoms. Over-the-counter antacids provide temporary relief for mild heartburn. For persistent symptoms, healthcare providers may prescribe H2 blockers (which reduce acid) or proton pump inhibitors (PPIs), which suppress stomach acid secretion. PPIs are typically taken daily before a meal for maximum effect.
Discuss all medications with a doctor, as some GERD treatments, especially PPIs, can have side effects or interact with other Lupus medications. PPIs have been linked to worsening certain skin conditions, like subacute cutaneous lupus erythematosus. Effective management of underlying Lupus through immunosuppressive therapies can also improve GERD symptoms by reducing inflammation.