Characterization of GI involvement in childhood-onset SLE

More than half of patients with childhood-onset systemic lupus erythematosus (SLE) patients present with gastrointestinal symptoms at the time of diagnosis, suggests a multicenter study from Turkey published in the journal Lupus.1 The most common initial presenting features were abdominal pain and raised liver enzymes.

This retrospective cohort study included 123 patients with childhood-onset SLE, aged ≤ 18 years, as confirmed by the Systemic Lupus International Collaborating Clinics criteria, from 16 referral departments of pediatric rheumatology. These children had features of GI involvement. Characterization of the GI manifestations was the objective of the study.

Over half of the study group (63.4%) had GI signs and symptoms when first diagnosed. The rest developed these manifestations after a median duration of 12 months. While two-thirds of the participants (66.7%) presented with GI-related symptoms, the remaining 33.3% were diagnosed based on laboratory findings.

Abdominal pain was the commonest presenting symptom (62.6%). Elevated liver enzymes (~60%), hepatomegaly (32.5%), diarrhea (21.1%), and jaundice (~9%) were the other presenting symptoms. In 78.6% patients, the GI signs and symptoms were associated with SLE. On the other hand, in 28.5% patients, the GI involvement was attributed to drug-related adverse events and in less than 1% patients to comorbid conditions.

Involvement of the kidneys or the central nervous system is more frequently observed in patients with SLE, although around 40% of them have GI involvement. While most GI symptoms are mild, some can be acute and potentially life-threatening such as lupus mesenteric vasculitis. Hence, SLE must be considered in the differential diagnosis when evaluating children presenting with GI manifestations. Also, children with SLE should be routinely screened for elevated hepatic transaminases, even if they do not have GI symptoms and evaluated further if GI involvement is suspected. These findings also make a case of inclusion of GI components in the SLE diagnostic criteria.

Reference

1.   Hafize Emine Sönmez, et al. Exploring gastrointestinal manifestations in childhood onset systemic lupus erythematosus - Insights from a multicenter study. Lupus. 2024 Aug 26:9612033241279071. doi: 10.1177/09612033241279071.