Literature Review

Clinical manifestations and progress in diagnosis and treatment of digestive system involvement in children with juvenile systemic lupus erythematosus

  • Tong Reviewer: JIN ,
  • Chang LIU ,
  • Xue Reviser: ZHAO
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  • Department of Pediatrics, Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, China

Received date: 2023-10-10

  Online published: 2024-10-08

Abstract

Digestive system involvement is common in juvenile systemic lupus erythematosus (JSLE). Gastrointestinal involvement occurs in 15% to 60% of children with JSLE, and 2% to 30% of gastrointestinal symptoms are directly attributable to JSLE. The main pathological changes of JSLE are inflammation and vasculitis, and the symptoms are not specific. Clinically, it can be manifested as lupus mesenteric vasculitis, hepatitis and pancreatitis, so early recognition is of great significance. For children with JSLE who present with digestive system symptoms, the cause should be identified based on objective laboratory findings and treated accordingly. Once it is clear that the digestive system is caused by JSLE itself, adequate glucocorticoids should be used intravenously at an early stage, and pulse therapy should be given if necessary. This paper reviews the progress of etiology, pathology, clinical manifestations, diagnosis, differential diagnosis and treatment of JSLE digestive system involvement, and provides suggestions for further improving the diagnosis and treatment norms applicable to JSLE digestive system involvement.

Cite this article

Tong Reviewer: JIN , Chang LIU , Xue Reviser: ZHAO . Clinical manifestations and progress in diagnosis and treatment of digestive system involvement in children with juvenile systemic lupus erythematosus[J]. Journal of Clinical Pediatrics, 2024 , 42(10) : 895 -901 . DOI: 10.12372/jcp.2024.23e0969

References

[1] Charras A, Smith E, Hedrich CM. Systemic lupus erythematosus in children and young people[J]. Curr Rheumatol Rep, 2021, 23(3): 20.
[2] Osaku FM, Fraga MM, Aires PP, et al. SLICC classification criteria for juvenile systemic lupus erythematosus: a cross sectional study[J]. Acta Reumatol Port, 2018, 43(4): 279-283.
[3] Frittoli RB, Vivaldo JF, Costallat LTL, et al. Gastrointestinal involvement in systemic lupus erythematosus: asystematic review[J]. J Transl Autoimmun, 2021, 4: 100106.
[4] Leone P, Prete M, Malerba E, et al. Lupus vasculitis: an overview[J]. Biomedicines, 2021, 9(11): 1626.
[5] Koga T, Ichinose K, Kawakami A, et al. Current insights and future prospects for targeting IL-17 to treat patients with systemic lupus erythematosus[J]. Front Immunol, 2021, 11: 624971.
[6] Hatemi I, Hatemi G, ?elik AF. Systemic vasculitis and the gut[J]. Curr Opin Rheumatol, 2017, 29(1): 33-38.
[7] Calle-Botero E, Abril A. Lupus vasculitis[J]. Curr Rheumatol Rep, 2020, 22(10): 71.
[8] Alharbi S. Gastrointestinal manifestations in patients with systemic lupus erythematosus[J]. Open Access Rheumatol, 2022, 14: 243-253.
[9] Halabi H, AlDabbagh A, Alamoudi A. Gastrointestinal manifestations of rheumatic diseases[M]//Almoallim H, Cheikh M, editors. Skills in rheumatology. Singapore: Springer, 2021: Chapter 23.
[10] Liu F, Ren T, Li X, et al. Distinct microbiomes of gut and saliva in patients with systemic lupus erythematous and clinical associations[J]. Front Immunol, 2021, 12: 626217.
[11] Girardelli M, Valencic E, Moressa V, et al. Genetic and immunologic findings in children with recurrent aphthous stomatitis with systemic inflammation[J]. Pediatr Rheumatol Online J, 2021, 19(1): 70.
[12] Chua S, Dodd H, Saeed IT, et al. Dysphagia in a patient with lupus and review of the literature[J]. Lupus, 2002, 11(5): 322-324.
[13] Carlé C, Mas E, Barreau F. Intestinal involvement in lupus: From pathophysiology to therapeutic perspectives[J]. Lupus, 2023, 32(4): 461-470.
[14] 王康健, 陈宏浦, 吕国荣, 等. 胃充盈超声造影对系统性红斑狼疮胃受累的诊断价值[J]. 中国超声医学杂志, 2016, 32(5): 437-439.
[15] Alsolaimani R. Mesenteric vasculitis and urinary system involvement presenting as the initial manifestations of systemic lupus erythematosus treated successfully with glucocorticoids and rituximab: a case report[J]. Cureus, 2022, 14(11): e31474.
[16] Xie JJ, Ling GC, Jiang YB, et al. Lupus with initial mesenteric vasculitis[J]. Rheumatol Immunol Res, 2023, 4(2): 102-103.
[17] Medina F, Ayala A, Jara LJ, et al. Acute abdomen in systemic lupus erythematosus: the importance of early laparotomy[J]. Am J Med, 1997, 103(2): 100-105.
[18] Ayari M, Nakhli A, Teyeb Z, et al. Intestinal pseudo-obstruction: unusual presentation of systemic lupus erythematous[J]. Clin Case Rep, 2021, 9(3): 1759-1762.
[19] Ohri AJ, Shah CG, Udani AH. Intestinal pseudo-obstruction - an under-recognized presentation of systemic lupus erythematosus[J]. Indian J Nephrol, 2022, 32(5): 476-479.
[20] Zheng J, Ni R, Liu H. Intestinal pseudo-obstruction in systemic lupus erythematosus: an analysis of nationwide inpatient sample[J]. Clin Rheumatol, 2022, 41(11): 3331-3335.
[21] Eguchi M, Iwanaga N, Sakai K, et al. Protein-losing gastroenteropathy in a patient with concomitant systemic lupus erythematosus and Sj?gren's syndrome[J]. Immunol Med, 2018, 41(1): 34-38.
[22] Li Z, Xu D, Wang Z, et al. Gastrointestinal system involvement in systemic lupus erythematosus[J]. Lupus. 2017, 26(11): 1127-1138.
[23] Lin Q, Zhang M, Tang H, et al. Acute pancreatitis and macrophage activation syndrome in pediatric systemic lupus erythematosus: case-based review[J]. Rheumatol Int, 2020, 40(5): 811-819.
[24] Gormezano NW, Otsuzi CI, Barros DL, et al. Macrophage activation syndrome: a severe and frequent manifestation of acute pancreatitis in 362 childhood-onset compared to 1830 adult-onset systemic lupus erythematosus patients[J]. Semin Arthritis Rheum, 2016, 45(6): 706-710.
[25] El Qadiry R, Bourrahouat A, Aitsab I, et al. Systemic lupus erythematosus-related pancreatitis in children: severe and lethal form[J]. Case Rep Pediatr, 2018, 2018: 4612754.
[26] Dima A, Balaban DV, Jurcut C, et al. Systemic lupus erythematosus-related acute pancreatitis[J]. Lupus, 2021, 30(1): 5-14.
[27] Marques VL, Gormezano NW, Bonfá E, et al. Pancreatitis subtypes survey in 852 childhood-onset systemic lupus erythematosus patients[J]. J Pediatr Gastroenterol Nutr, 2016, 62(2): 328-334.
[28] Abughazaleh S, Alsakarneh S, Hattar M, et al. Systemic lupus erythematosus in disguise: acute pancreatitis as initial presentation[J]. J Investig Med High Impact Case Rep, 2023, 11: 23247096231185480.
[29] González-Regueiro JA, Cruz-Contreras M, Merayo-Chalico J, et al. Hepatic manifestations in systemic lupus erythematosus[J]. Lupus, 2020, 29(8): 813-824.
[30] Adiga A, Nugent K. Lupus hepatitis and autoimmune hepatitis (lupoid hepatitis)[J]. Am J Med Sci, 2017, 353(4): 329-335.
[31] Tani C, Elefante E, Arnaud L, et al. Rare clinical manifestations in systemic lupus erythematosus: a review on frequency and clinical presentation[J]. Clin Exp Rheumatol, 2022, 134(5): 93-102.
[32] Mendon?a JA, Marques-Neto JF, Prando P, et al. Acute acalculous cholecystitis in juvenile systemic lupus erythematosus[J]. Lupus, 2009, 18(6): 561-563.
[33] Xu H, Meng X, Wang L, et al. Dietary patterns and life-styles of patients with gastrointestinal involvement of systemic lupus erythematosus: Questionnaire survey from a tertiary center of China[J]. Lupus, 2023, 32(4): 477-488.
[34] Luo S, Long H, Lu Q. Recent advances in understanding pathogenesis and therapeutic strategies of systemic lupus erythematosus[J]. Int Immunopharmacol, 2020, 89: 107028.
[35] Trindade VC, Carneiro-Sampaio M, Bonfa E, et al. An update on the management of childhood-onset systemic lupus erythematosus[J]. Paediatr Drugs, 2021, 23(4): 331-347.
[36] Kenar G, Atay K, Yüksek GE, et al. Gastrointestinal vasculitis due to systemic lupus erythematosus treated with rituximab: a case report[J]. Lupus, 2020, 29(6): 640-643.
[37] 朱万红, 王秀丽, 赵成广, 等. 贝利尤单抗治疗以呕吐尿频为首发症状的儿童系统性红斑狼疮一例[J]. 国际儿科学杂志, 2021, 48(3): 214-216.
[38] Mauro A, Giani T, Di Mari C, et al. Gastrointestinal involvement in children with systemic lupus erythematosus[J]. Children (Basel), 2023, 10(2): 309.
[39] Trapani S, Rubino C, Simonini G, et al. Gastrointestinal and hepatic involvement in paediatric systemic lupus erythematosus[J]. Clin Exp Rheumatol, 2021, 39(4): 899-906.
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