11.13.15 SFGH Ambulatory Report Pearls: Abdominal Pain + Rheumatologic Dz

Gastrointestinal Manifestations in Rheumatologic Disorders

  • SLE – lupus enteritis can affect the entire GI tract and commonly present with oral ulcers; esophageal symptoms are typically esophageal dysphagia or odynophagia; associated vasculitidies can lead to ulcerations
  • Sjogren’s syndrome – sicca syndromes (e.g., dry eyes, dry mouth) can lead to dysphagia; chronic atrophic gastritis is common and can lead to epigastric pain, dyspepsia, and nausea; can also have involvement of the liver and biliary tree and hepatic involvement is estimated to affect 7% of patients with Sjogren’s syndrome
  • Scleroderma – typically presents with motility issues and is often a presenting symptom of scleroderma; most common symptoms are dysphagia and dyspepsia given incomplete closure of the lower esophageal sphincter; can predispose to Barrett’s metaplasia
  • Polyarteritis nodosa – symptoms typically result from chronic mesenteric ischemia resulting in chronic abdominal pain; hematemesis, melena, and hematochezia are more common than in the other rheumatologic disorders presented here
  • Rheumatoid arthritis – can have involvement of TMJ which impedes chewing; can be associated with motility disorders
  • Behcet’s disease – typically presents with ulcerations throughout digestive tract; mucosal ulcers are incredibly painful; ulcerations can result in perforations
  • Other disorders that have GI manifestations – the list is extensive and includes myositis, GCA, HSP, Takayasu, APLS amongst others
  • Important to note that SLE, Sjogren’s syndrome, and Scleroderma all commonly affect the esophagus and may present with symptoms of GERD

Pancreatic Calcifications

The four diagnoses associated with pancreatic calcifications per Dr. Cello:

  1. Cystic fibrosis
  2. Idiopathic familial pancreatitis
  3. Alcoholic pancreatitis
  4. Indian subtriopical pancreatitis

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