Mader R, Adawi M, Schonfeld S
Department of Medicine A, Haemek Medical Center, Afula, Israel.
Clin Exp Rheumatol. 1997 Nov-Dec;15(6):659-61.
To screen patients with SLE for malabsorption.
Twenty-one patients fulfilling the American College of Rheumatology (ACR) criteria for SLE were enrolled in the study. Patients were screened for malabsorption by the D-Xylose test (DXT) and by microscopic examination of the stool for fat droplets. All patients underwent upper GI endoscopy with biopsy from the second portion of the duodenum. The specimen was examined for morphologic abnormalities and for the presence of IgG, IgM, IgA, and kappa and lambda light chains. Ten patients without SLE served as controls.
A history of abdominal pain and occasional diarrhea was elicited in 2/21 patients. These patients were found to have an abnormal DXT and excessive fecal fat excretion. In one of these patients, histologic examination revealed flattened and deformed villi with an inflammatory infiltrate. Two other patients showed isolated excessive fecal fat excretion with a normal microscopic appearance of the mucosa. In 20/21 patients the small bowel histology was normal. In all patients, immunoperoxidase staining revealed a normal quantity and distribution of the immunoglobulins and light chains within the intestinal mucosa. No correlation was demonstrated between CH50, C3, C4, anti-dsDNA levels and the malabsorption.
In this series of SLE patients, the prevalence of malabsorption was 9.5%, and was even higher if isolated fat malabsorption was considered. A search for malabsorption in patients with SLE, and in particular in those with abdominal complaints, is recommended. The pathogenesis is not yet clear and warrants further investigation.
