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. 1998 Jul;43(1):117–122. doi: 10.1136/gut.43.1.117

Chronic intestinal pseudo-obstruction in systemic lupus erythematosus

G Perlemuter 1, S Chaussade 1, B Wechsler 1, P Cacoub 1, M Dapoigny 1, A Kahan 1, P Godeau 1, D Couturier 1
PMCID: PMC1727185  PMID: 9771415

Abstract

Background/Aims—Chronic intestinal pseudo-obstruction (CIPO) reflects a dysfunction of the visceral smooth muscle or the enteric nervous system. Gastrointestinal manifestations are common in systemic lupus erythematosus (SLE) but CIPO has not been reported. Features of CIPO are reported in five patients with SLE. 
Methods—From 1988 to 1993, five patients with SLE or SLE-like syndrome were hospitalised for gastrointestinal manometric studies. CIPO was the onset feature in two cases. Antroduodenal manometry (three hours fasting, two hours fed) was performed in all patients, and oesophageal manometry in four. 
Results—Intestinal hypomotility associated with reduced bladder capacity and bilateral ureteral distension was found in four patients and aperistalsis of the oesophagus in three. Treatment, which consisted of high dose corticosteroids, parenteral nutrition, promotility agents, and antibiotics, led to remission of both CIPO and urinary abnormalities in all cases. Antroduodenal manometry performed in two patients after remission showed increased intestinal motility. One patient died, and postmortem examination showed intestinal vasculitis. 
Conclusions—CIPO in SLE is a life threatening situation that can be reversed by treatment. It may be: (a) a complication or onset feature of the disease; (b) secondary to smooth muscle involvement; (c) associated with ureteral and vesical involvement; (d) the result of intestinal vasculitis. 



Keywords: chronic intestinal pseudo-obstruction; systemic lupus erythematosus

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Figure 1 .

Figure 1

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Plain abdominal radiograph (upright film). Gaseous distension of the small bowel with the presence of fluid in the bowel loops is observed. 


Figure 2 .

Figure 2

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Urinary involvement during systemic lupus erythematosus and chronic intestinal pseudo-obstruction (intravenous urography). There is an increase in the thickness of the bladder wall with marked reduction in capacity associated with bilateral ureteral distension (patient 1). 


Figure 3 .

Figure 3

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Fasting gastrointestinal motility tracings in patient 5. Intestinal hypomotility is observed with weak distal antral, duodenal, and jejunal contractions suggestive of a myopathic disorder. A, antrum (1 to 4, proximal to distal); P, pylorus; D2, descending duodenum; D4, distal duodenum; J, jejunum. 


Figure 4 .

Figure 4

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Treatment of patients and outcomes. 


Figure 5 .

Figure 5

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(A) Postprandial motility tracings before treatment (patient 1): a reduction in amplitude of gastrointestinal contractions can be seen. (B) Postprandial motility tracings after one year of treatment (patient 1): increased antral and intestinal motility can be seen. A, antrum (1 to 4, proximal to distal); P, pylorus; D2, descending duodenum; D4, distal duodenum; J, jejunum. 


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