Lupus Stomach Medications: Gastrointestinal Symptoms

posted in Diet And Lupus on October 17, 2023 by

Gavin Abson

Updated February 15, 2025

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Gastrointestinal (GI) symptoms and problems are common in lupus patients and can significantly impact their quality of life. This article will explore lupus stomach medications and strategies for managing GI symptoms effectively.

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NOTE: Johns Hopkins University Press, publisher of The Lupus Encyclopedia, is a nonprofit publisher. If you purchase JHUP books, like The Lupus Encyclopedia, you support projects like Project MUSE.

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This blog on Gastrointestinal Symptoms and Lupus Stomach Medications was edited and contributed to by Donald Thomas, MD; author of “The Lupus Encyclopedia.” Parts of this blog post come from “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Health Care Providers, edition 2“

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Understanding Gastrointestinal Symptoms in Lupus

Gastrointestinal symptoms in lupus can vary widely and may include:

Abdominal Pain

Lupus can cause inflammation in the abdominal area, leading to persistent or intermittent abdominal pain. There are many different areas in which lupus can cause inflammation. Lupus inflammation of the blood vessels (vasculitis), the lining of the abdomen around the organs (peritonitis, a type of serositis), the gall bladder (cholecystitis), the pancreas (pancreatitis), and the lining of the intestines (enteritis and inflammatory bowel disease) are some examples.

Of course, lupus patients can develop abdominal pain for many reasons unrelated to lupus as well. These include medication side effects, ulcers, gall bladder problems, infections, and irritable bowel syndrome are some examples. Many lupus problems that can cause the GI symptoms below can also cause abdominal pain. 

Nausea and Vomiting

Some lupus patients experience nausea and vomiting (N/V), which can be caused by the disease itself, as a side effect of medications, or due to many other conditions (for example, gall bladder problems, irritable bowel syndrome, ulcers, and even pregnancy). N/V in SLE patients is most commonly due to medications. If you notice nausea after starting a new medication, it is most likely due to the medicine. Let your doctor know right away. We do not want patients to have side effects like nausea. We can get rid of the nausea by lowering the dose, changing to a different medicine, or giving an antinausea drug like ondansetron. 

N/V occurs in around 8% of SLE patients during lupus flares. It could be related to inflammation around the abdominal organs (peritonitis), inflammation of any GI tract organs, or even vasculitis (blood vessel inflammation). When due to SLE, it usually resolves after immunosuppressant (immunomodulatory) treatment, like steroids.

Diarrhea or Constipation

Gastrointestinal inflammation can disrupt normal bowel function, leading to diarrhea or constipation. Diarrhea is most commonly due to medications (and addressed similarly as above) or infection. Difficulty absorbing nutrients from food (malabsorption) can also cause diarrhea (as in celiac disease). Protein-losing enteropathy is a rare lupus problem.

Heartburn and Acid Reflux

Lupus patients may experience symptoms like heartburn and acid reflux. This could be due to a loose sphincter muscle between the esophagus and stomach, a hiatal hernia, obesity, ingesting certain foods (like chocolate or alcohol), or weak esophagus muscles due to lupus inflammation. It is important to abide by the lifestyle changes listed below under “Lupus Stomach Medications.” If those are unsuccessful, let your doctor know. Your doctor may need to look down into the esophagus and stomach using an upper endoscopy or esophagogastroduodenoscopy. 

Loss of Appetite and Weight Loss

Gastrointestinal symptoms can reduce appetite and unintended weight loss. Weight loss can be due to lupus (lupus cachexia) when lupus is very active and causes systemic inflammation. However, doctors will also want to run tests to ensure other causes are not occurring, such as other GI disorders, thyroid disease, infection, depression, anxiety disorder, and cancer (to name a few potential causes). 

     Medications can cause many GI symptoms (such as nausea, stomach pain, diarrhea, constipation, heartburn, acid reflux, appetite loss, and weight loss). These problems typically begin soon after starting the medication, making it easy to identify. In this case, the drug should be stopped, or the dosage decreased. But they can sometimes occur after someone has been on medication for a while. In that case, several medicines may need to be stopped and reintroduced one at a time to determine which one is causing the problem.

     Abdominal pain, nausea, heartburn, and N/V can also be due to other problems not related to lupus inflammation. These potential problems include as ulcers, irritable bowel syndrome, gall bladder issues, pancreatic disease, urinary tract infections, and even pregnancy. Figuring out the cause of GI symptoms can be complicated, requiring many tests and the involvement of other specialists, such as gastroenterologists.

Lupus Stomach Medications

Managing gastrointestinal symptoms in lupus often involves a combination of medications and lifestyle modifications. Here are some medications commonly used to address lupus-related stomach issues:

1. Proton Pump Inhibitors (PPIs) and histamine-2 receptor blockers (H2 blockers)

• How They Work: PPIs (like omeprazole and pantoprazole) and H2 blockers (like Pepcid) reduce stomach acid production, which can help relieve symptoms of acid reflux and heartburn.

• When They Are Used: PPIs and H2 blockers are often prescribed for lupus patients with acid-related GI symptoms.
  • H2 blockers include cimetidine (Tagamet), famotidine (Pepcid), and nizatidine. While PPIs usually work better than H2 blockers, H2 blockers are less expensive, so some insurance companies require people to take an H2 blocker before taking a PPI.
  • PPIs are not all the same, though. One PPI may work better than another. Therefore, trials of different PPIs at different doses are sometimes needed. It is important to take the PPI on an empty stomach one hour before eating a meal with protein. Some people also do better if they take a PPI in the morning and an H2 blocker in the evening. They work in two different complementary ways. It is not recommended to take both at the same time.

LIST OF PPIs

• dexlansoprazole (Dexilant)                       
• esiomeprazole (Nexium)
• omeprazole (Prilosec, Zegerid, OmePPi)
• lansoprazole (Prevacid)
• pantoprazole (Protonix)
• rabeprazole (Aciphex)   
•     PPIs are generally safe. However, they can decrease magnesium and vitamin B12 absorption. We check vitamin B12 and magnesium levels regularly in patients taking PPIs.
      Prolonged PPI use can potentially cause other problems. These include broken bones from osteoporosis, C. difficile infection (an intestinal bacterial infection), microscopic colitis (inflammation in the large intestine), and atrophic gastritis (an abnormality of the stomach lining). Doctors recommend limiting PPI use to avoid these. A common approach is to use a PPI daily for eight weeks and then cut it down to an as-needed basis.
       Another reason for cutting down on PPIs is that studies suggest they cause chronic kidney disease, dementia, or pneumonia. However, we do not know if these are actual side effects or not—the studies suggesting that PPIs may cause these are not well-designed and do not prove that these are problems.
•      PPIs can cause the new onset of subacute cutaneous lupus erythematosus (SCLE), or cause existing SCLE to worsen. This can occur weeks to many months after starting the PPI. If you develop SCLE and are taking a PPI, it is prudent to stop the PPI and substitute other medications like H2-blockers. After halting the PPI, the SCLE can take several months to improve. 

2. Immunomodulators

• How They Work: Medications like hydroxychloroquine, steroids, anifrolumab (Saphnelo), belimumab (Benlysta), cyclophosphamide, methotrexate, azathioprine, and mycophenolate mofetil for lupus can help calm down the immune system, reducing inflammation in the GI tract.
• When They Are Used: These medications may be considered for lupus patients with GI lupus inflammation. Conditions where these drugs may be used include peritonitis (inflammation of the lining of the abdomen), lupus pancreatitis (pancreas inflammation), vasculitis, and lupus enteritis (intestinal inflammation). Doctors do not prescribe these drugs for nonspecific symptoms, such as nausea or heartburn (unless lupus inflammation is the cause).

3. Anti-Nausea Medications

• How They Work: Medications like ondansetron (Zofran) can help control nausea and vomiting.
• When They Are Used: Anti-nausea medications may be prescribed as needed for lupus patients experiencing nausea and vomiting.
  

4. Diet and Lifestyle Modifications

All patients with heartburn, gastroesophageal reflux disease (GERD or reflux), hiatal hernia, or who have problems with the esophagus working correctly (like esophageal dysmotility) should practice dietary and lifestyle modifications. Doing so helps reduce the amount of medications needed. 

• Dietary Changes: Lupus patients may benefit from dietary modifications, such as avoiding trigger foods that worsen GI symptoms (e.g., spicy or fatty foods).
• Stress Management: Stress can exacerbate GI symptoms. Stress reduction techniques, like yoga or meditation, may help.
• Heartburn and Acid Reflux Prevention Measures:
  • Eat smaller, more frequent meals.
  • Take small bites of food and small sips of liquids at a time.
  • Eat food slowly. Put the fork down after each bite. Pick it back up after completely swallowing.
  • Use xylitol lozenges or gum before eating (increases saliva flow)
  • Avoid substances that relax the LES (like caffeine, tobacco, chocolate, peppermint, high-fat food, and alcohol): they worsen GERD.
  • Avoid highly acidic foods like soda, citrus juices, tomatoes, and wine.
  • If possible, stop drugs that worsen GERD (table 28.1)
  • Avoid tight clothing and belts (they increase pressure on the stomach).
  • Maintain normal weight (abdominal fat puts pressure on the stomach).
  • Do not lie down for at least two to three hours after eating or drinking.
  • Avoid exercise and bending at the waist for one to two hours after eating.
  • Maintain good posture. Sit and stand upright.
  • Elevate the head of the bed on six- to eight-inch blocks or furniture risers.

Anti-Reflux Drugs and Lupus Stomach Medications

Anti-reflux drugs are often considered if changing lifestyle habits or changing offending medications do not stop the symptoms. If symptoms are mild and intermittent, then over-the-counter preparations can be tried. These include Tums, Alka-Seltzer, Pepto Bismol, Mylanta, Rolaids, Prilosec, Pepcid Complete, and Tagamet. But check with your doctor before taking these. Some interact with other drugs or should not be used with some medical problems.

Your doctor may put you on anti-acid prescription medicine. This can help you feel better and prevent some GERD complications. For example, aluminum sucrose sulfate (Sucralfate) coats and protects the esophagus and stomach lining. It can help people with mild GERD, especially when problems occur after eating.

Other anti-GERD drugs typically lower stomach content acidity. Prescription-strength medicines that reduce stomach acid are divided into two main groups: proton pump inhibitors (PPIs) (table 28.3) and histamine type 2 (H2) blockers. These are discussed above in section 1. 

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For more in-depth information on lupus gastrointestinal problems and lupus stomach medications:

Read chapters 15 and 28 of The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

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For more in-depth information on Lupus Stomach Medications: Gastrointestinal Symptoms:

Read more in The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

If you enjoy the information from The Lupus Encyclopedia, please click the “SUPPORT” button at the top of the page to learn how you can help. 

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