Abdominal Pain Signals GI Involvement in Pediatric Lupus

TOPLINE:

Gastrointestinal involvement is common in childhood-onset lupus, with more than half of the patients presenting with gastrointestinal symptoms at diagnosis. Abdominal pain and elevated hepatic transaminases are the most common initial signs.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to explore the prevalence and characteristics of gastrointestinal involvement in childhood-onset systemic lupus erythematosus (SLE).
• They included 123 patients aged ≤ 18 years (82.1% girls) with childhood-onset SLE from 16 referral departments of pediatric rheumatology in Turkey who showed gastrointestinal system (GIS) involvement either during diagnosis or the course of the disease.
• The mean age at diagnosis was 12.5 years, and the median follow-up duration was 44.5 months.
• Demographic information, clinical manifestations, laboratory findings, radiological and endoscopic assessments, histopathological analyses, treatments, and clinical outcomes were retrospectively extracted from patient records; disease activity and cumulative organ damage were also assessed.

TAKEAWAY:

• At the time of SLE diagnosis, 63.4% of patients presented with gastrointestinal involvement, while others (36.6%) developed gastrointestinal symptoms after a median of 12 months.
• Abdominal pain was the most common initial symptom, observed in 62.6% of patients, followed by elevated hepatic transaminases in 56.9%.
• The most common type of gastrointestinal involvement was autoimmune hepatitis (25.2%), followed by hepatic steatosis (13%), and lupus hepatitis (11.3%).
• The gastrointestinal manifestations were directly attributed to SLE in 82 patients, were drug-related in 35 patients, and due to comorbidities in six patients.

IN PRACTICE:

“It is crucial to consider SLE in the differential diagnosis of GIS [gastrointestinal system] manifestations in children. The inclusion of GIS involvement as a new diagnostic criterion may be warranted, given its potential prevalence that might be higher than currently recognized,” the authors wrote.

SOURCE:

This study was led by Hafize Emine Sönmez, MD, Department of Pediatric Rheumatology, Kocaeli University, İzmit, Turkey, and was published online on August 26, 2024, in Lupus. 

LIMITATIONS:

The retrospective nature of the study may have limited the ability to establish causality between gastrointestinal symptoms and SLE. This study also did not include a comparison between patients with childhood-onset SLE with gastrointestinal involvement and those without. Moreover, the study relied on patient records for data collection, which may have introduced bias.

DISCLOSURES:

This study did not receive any financial support. The authors declared no potential conflict of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.