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. While lupus is widely recognized for its effects on joints, skin, and kidneys, it can also impact the gastrointestinal system and other bodily functions. Vomiting, though not always the most prominent symptom associated with lupus, can be a manifestation of the disease itself or a side effect of its treatments.
Lupus Impact on the Digestive System
Lupus can directly affect the gastrointestinal (GI) tract, leading to various symptoms, including vomiting. One specific condition is lupus enteritis, which involves inflammation of the small bowel. This inflammation can cause abdominal pain, nausea, loss of appetite, bloating, and vomiting. Severe cases may mimic an acute surgical abdomen.
Another direct manifestation is mesenteric vasculitis, where the blood vessels supplying the intestines become inflamed. This inflammation can lead to reduced blood flow to the bowel, causing severe abdominal pain, nausea, vomiting, and diarrhea. Imaging techniques like CT scans often reveal signs such as bowel wall thickening, dilated intestines, and engorged mesenteric vessels, sometimes referred to as the “comb sign.” This condition can be serious and, if not promptly treated, may lead to complications like bowel infarction or perforation.
Protein-losing enteropathy is another GI complication of lupus, characterized by the loss of serum proteins through the gastrointestinal tract. While vomiting is not a primary symptom, this condition can cause abdominal pain, varying degrees of diarrhea, and swelling due to low protein levels in the blood. This condition is rare but can be an initial manifestation of lupus.
Lupus Affecting Other Body Systems
Lupus activity in body systems beyond the digestive tract can also indirectly lead to vomiting. When lupus affects the kidneys, a condition known as lupus nephritis, severe kidney dysfunction can occur. This can lead to a buildup of waste products and toxins in the blood, a condition called uremia, which commonly causes nausea and vomiting.
Lupus involvement in the central nervous system (CNS) can also trigger vomiting. Conditions such as lupus cerebritis or vasculitis affecting the brain may cause increased pressure within the skull or other neurological disturbances. These neurological issues can manifest as symptoms like headaches, seizures, and vomiting.
Lupus can contribute to or be associated with various metabolic imbalances. These disturbances, including electrolyte abnormalities, can disrupt normal bodily functions and induce nausea and vomiting. Identifying the underlying systemic cause is important for effective management of these symptoms.
Medication Side Effects
Vomiting can also arise as a side effect of medications commonly used to manage lupus. Nonsteroidal anti-inflammatory drugs (NSAIDs), often prescribed for pain and inflammation, can cause gastrointestinal irritation, leading to nausea, vomiting, and stomach pain. Taking NSAIDs with food or milk can help reduce these side effects.
Corticosteroids, such as prednisone, are powerful anti-inflammatory and immunosuppressive drugs used in lupus treatment. These medications can cause gastrointestinal upset, including nausea and vomiting, especially if taken on an empty stomach. Taking them with food often helps to mitigate these symptoms.
Immunosuppressants are another class of drugs that can induce vomiting. Methotrexate, for instance, frequently causes nausea and vomiting. Azathioprine can also lead to nausea and vomiting.
Mycophenolate mofetil commonly causes gastrointestinal issues like diarrhea, nausea, and vomiting. Cyclophosphamide, a stronger immunosuppressant, is also known to cause severe nausea and vomiting.
When to Seek Medical Care and Management
Persistent or severe vomiting in individuals with lupus warrants prompt medical attention. It is important to seek care if vomiting is accompanied by signs of dehydration, such as decreased urination, excessive thirst, or lightheadedness. Other concerning symptoms that require immediate evaluation include severe abdominal pain, fever, blood in the vomit, or an inability to keep down medications.
Communicating all symptoms to a healthcare provider is important for accurate diagnosis and tailored management. The approach to managing vomiting in lupus depends on identifying its underlying cause, whether it is disease activity or medication side effects. Management strategies may include antiemetic medications, dietary adjustments to minimize gastric upset, and modifications to lupus treatment plans. Addressing the specific cause of vomiting can help improve comfort and overall health outcomes.