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Article: Intestinal pseudo-obstruction in systemic lupus erythematosus: An uncommon but important clinical manifestation

TitleIntestinal pseudo-obstruction in systemic lupus erythematosus: An uncommon but important clinical manifestation
Authors
Issue Date2000
PublisherSage Publications Ltd. The Journal's web site is located at http://lup.sagepub.com
Citation
Lupus, 2000, v. 9 n. 1, p. 11-18 How to Cite?
AbstractObjectives: To document intestinal pseudo-obstruction (IpsO) as a recognised clinical manifestation of systemic lupus erythematosus (SLE) and a possible new clinical entity with its apparent association with ureterohydronephrosis. Methodology: We report six lupus patients who presented with IpsO and review 12 other cases from an English literature search. IpsO is defined as the presence of clinical features suggestive of intestinal obstruction but without organic obstruction, namely absence of bowel sounds, presence of multiple fluid levels on plain abdominal X-rays and exclusion of organic obstruction by imaging or surgical procedure. Other clinical characteristics related to the underlying lupus, serological and histological findings, treatment modalities and outcomes of these patients were reviewed. Results: All 18 patients fulfilled the ACR revised classification criteria for SLE. None showed any clinical features of scleroderma or overlap syndrome. The mean age of onset of IpsO was 29.0 (15-47) y. The female to male ratio was 16:2. Nine patients had IpsO as the initial presentation of their underlying lupus. Coexisting lupus involvement of other organ systems included glomerulonephritis (n = 7), thrombocytopenia (n = 5) and cerebral lupus (n = 3). The serology data and autoantibody profile of some of the previously reported patients were incomplete. In our series, anti-Ro antibody was positive in 5/6 while anti-RNP was found in 1/6 patients only. All our patients had active lupus serology at presentation. 17/18 patients required the use of high dose systemic corticosteroid therapy while one patient responded to topical adrenocorticotrophin hormone treatment. Response was good and was observed early after commencement. Azathioprine was used as maintenance therapy in 6/18 patients with good effects. An apparent association with the presence of bilateral ureterohydronephrosis was found in 12/18 patients. These patients presented with dysuria without positive bacterial culture though features of chronic interstitial cystitis were not invariably found in these patients. Conclusion: IpsO is an uncommon but important manifestation of SLE. The underlying pathology is not fully understood but it may be related to immune complex deposition. The finding of coexisting ureterohydronephrosis suggests that there may also be a central smooth muscle motility problem of neuropathic or myogenic pathophysiology which may or may not be secondary to vasculitis. Early recognition and treatment of IpsO in SLE is important.
Persistent Identifierhttp://hdl.handle.net/10722/162419
ISSN
2015 Impact Factor: 2.118
2015 SCImago Journal Rankings: 0.878
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorMok, MYen_US
dc.contributor.authorWong, RWSen_US
dc.contributor.authorLau, CSen_US
dc.date.accessioned2012-09-05T05:19:45Z-
dc.date.available2012-09-05T05:19:45Z-
dc.date.issued2000en_US
dc.identifier.citationLupus, 2000, v. 9 n. 1, p. 11-18en_US
dc.identifier.issn0961-2033en_US
dc.identifier.urihttp://hdl.handle.net/10722/162419-
dc.description.abstractObjectives: To document intestinal pseudo-obstruction (IpsO) as a recognised clinical manifestation of systemic lupus erythematosus (SLE) and a possible new clinical entity with its apparent association with ureterohydronephrosis. Methodology: We report six lupus patients who presented with IpsO and review 12 other cases from an English literature search. IpsO is defined as the presence of clinical features suggestive of intestinal obstruction but without organic obstruction, namely absence of bowel sounds, presence of multiple fluid levels on plain abdominal X-rays and exclusion of organic obstruction by imaging or surgical procedure. Other clinical characteristics related to the underlying lupus, serological and histological findings, treatment modalities and outcomes of these patients were reviewed. Results: All 18 patients fulfilled the ACR revised classification criteria for SLE. None showed any clinical features of scleroderma or overlap syndrome. The mean age of onset of IpsO was 29.0 (15-47) y. The female to male ratio was 16:2. Nine patients had IpsO as the initial presentation of their underlying lupus. Coexisting lupus involvement of other organ systems included glomerulonephritis (n = 7), thrombocytopenia (n = 5) and cerebral lupus (n = 3). The serology data and autoantibody profile of some of the previously reported patients were incomplete. In our series, anti-Ro antibody was positive in 5/6 while anti-RNP was found in 1/6 patients only. All our patients had active lupus serology at presentation. 17/18 patients required the use of high dose systemic corticosteroid therapy while one patient responded to topical adrenocorticotrophin hormone treatment. Response was good and was observed early after commencement. Azathioprine was used as maintenance therapy in 6/18 patients with good effects. An apparent association with the presence of bilateral ureterohydronephrosis was found in 12/18 patients. These patients presented with dysuria without positive bacterial culture though features of chronic interstitial cystitis were not invariably found in these patients. Conclusion: IpsO is an uncommon but important manifestation of SLE. The underlying pathology is not fully understood but it may be related to immune complex deposition. The finding of coexisting ureterohydronephrosis suggests that there may also be a central smooth muscle motility problem of neuropathic or myogenic pathophysiology which may or may not be secondary to vasculitis. Early recognition and treatment of IpsO in SLE is important.en_US
dc.languageengen_US
dc.publisherSage Publications Ltd. The Journal's web site is located at http://lup.sagepub.comen_US
dc.relation.ispartofLupusen_US
dc.subject.meshAdulten_US
dc.subject.meshAge Distributionen_US
dc.subject.meshAge Of Onseten_US
dc.subject.meshFemaleen_US
dc.subject.meshGastrointestinal Agents - Therapeutic Useen_US
dc.subject.meshHumansen_US
dc.subject.meshHydronephrosis - Etiologyen_US
dc.subject.meshIleal Diseases - Diagnosis - Drug Therapy - Etiologyen_US
dc.subject.meshImmunosuppressive Agents - Therapeutic Useen_US
dc.subject.meshIntestinal Pseudo-Obstruction - Diagnosis - Drug Therapy - Etiologyen_US
dc.subject.meshLupus Erythematosus, Systemic - Complications - Drug Therapyen_US
dc.subject.meshLupus Nephritis - Complicationsen_US
dc.subject.meshLupus Vasculitis, Central Nervous System - Complicationsen_US
dc.subject.meshSerositis - Etiologyen_US
dc.subject.meshSex Distributionen_US
dc.subject.meshThrombocytopenia - Complicationsen_US
dc.titleIntestinal pseudo-obstruction in systemic lupus erythematosus: An uncommon but important clinical manifestationen_US
dc.typeArticleen_US
dc.identifier.emailMok, MY:temy@hkucc.hku.hken_US
dc.identifier.emailLau, CS:cslau@hku.hken_US
dc.identifier.authorityMok, MY=rp00490en_US
dc.identifier.authorityLau, CS=rp01348en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1177/096120330000900104-
dc.identifier.pmid10713642-
dc.identifier.scopuseid_2-s2.0-0034064355en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0034064355&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume9en_US
dc.identifier.issue1en_US
dc.identifier.spage11en_US
dc.identifier.epage18en_US
dc.identifier.isiWOS:000085870200003-
dc.publisher.placeUnited Kingdomen_US
dc.identifier.scopusauthoridMok, MY=7006024184en_US
dc.identifier.scopusauthoridWong, RWS=34875928200en_US
dc.identifier.scopusauthoridLau, CS=14035682100en_US

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