Systematic review of treatments for the gastrointestinal manifestations of systemic lupus erythematosus
- PMID: 39461088
- DOI: 10.1016/j.semarthrit.2024.152567
Systematic review of treatments for the gastrointestinal manifestations of systemic lupus erythematosus
Abstract
Objectives: To comprehensively assess and present the evidence for treatments used in the management of the gastrointestinal manifestations of SLE.
Methods: A systematic search of the literature from January 1990 to June 2022 was performed using the following databases: MEDLINE, EMBASE, PubMed and Cochrane. Key words relating to the gastrointestinal system, SLE, and treatment were used. Where there was sufficient evidence for the treatment of a manifestation, we excluded case series with <10 cases and case reports. However, for rarer manifestations with insufficient higher-level evidence, smaller case series and case reports were included.
Results: A total of 29 studies including 767 patients were included in the review; six cohort studies, 11 case-control studies, and 11 case series. Specific gastrointestinal manifestations included enteritis (5 studies), mesenteric vasculitis (3 studies), acute pancreatitis (5 studies), chronic pancreatitis (1 study), intestinal pseudo-obstruction (IPO) (2 studies), hepatitis (4 studies), protein-losing enteropathy (PLE) (6 studies), acute acalculous cholecystitis (2 studies), and Budd-Chiari Syndrome (1 study). Evidence for the treatment of Ascites (13 case reports), peritonitis (3 case reports), and miscellaneous GI manifestations (11 case reports) are included as a supplemental file. Most studies demonstrated a benefit from pulsed intravenous methylprednisolone (IVMP) in severe or life-threatening manifestations, and oral prednisolone for less severe manifestations. However, the quality of evidence was low, with a high risk of bias in all studies.
Conclusion: This review highlights the need for standardised disease definitions and terminology, as well as consideration of including gastrointestinal manifestations in disease scoring systems. There is a significant need for high-quality clinical trials in the treatment of the gastrointestinal manifestations of SLE, which will likely need to be multi-centre. We hope that this review will promote awareness of the gastrointestinal manifestations of SLE, and serve as a practical guide for evidence-based treatment.
Keywords: Gastrointestinal; Immunosuppressive treatments; Lupus; Systemic lupus erythematosus.
Copyright © 2024. Published by Elsevier Inc.
Conflict of interest statement
Declaration of competing interest The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for [Journal name] and was not involved in the editorial review or the decision to publish this article. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mandana Nikpour holds a National Health and Medical Research Council of Australia (NHMRC) Investigator Grant (GNT1176538) and has received: research grants from Janssen and Boehringer Ingelheim; Consulting fees from AstraZeneca and GSK; honoraria for presentations from AstraZeneca, GSK and Boehringer Ingelheim. Mandana Nikpour is a member of the Editorial Board of the Journal of Scleroderma and Related Disorders and was not involved in the editorial review or the decision to publish this article. Yanjie Hao holds a Melbourne Research scholarship from the University of Melbourne. Luke Williamson was recipient of a Ken Muirden Overseas Travelling Fellowship from Arthritis Australia. Chamara Basnayake has received speaker fees from Ferring Pharmaceuticals.
References
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
