Inflammatory Bowel Disease and Lupus
Inflammatory bowel disease is a potentially serious condition that can occur alongside lupus, severely affecting the health of the gut and the whole body.
Digestive issues are common for people with lupus, but figuring out the cause isn’t always simple. Abdominal pain, diarrhea, or bloating might be linked to lupus itself, or they could signal another condition, like inflammatory bowel disease (IBD). That uncertainty can be frustrating, especially if you’ve ever felt brushed aside when bringing up gut symptoms. You’re not alone in this experience. Understanding how lupus and IBD overlap can help you and your doctors find the right answers and treatment.
What is Inflammatory Bowel Disease?
Inflammatory Bowel Disease (IBD) is a group of autoimmune diseases where the immune system attacks the digestive tract (the small and large intestines). Inflammation damages the membranes between the food that they are digesting and the bloodstream. This makes it difficult for the body to take in enough nutrients and water. You can read more about inflammation in the intestinal membrane, here.
This can also cause problems with the microflora - the “good” bacteria, viruses, and other microbial life - that live in the gut and are essential to producing nutrients, defending against invading microorganisms, and regulating the immune system.
The symptoms of IBD include:
belly pain
diarrhea, constipation, and painful defecation
rectal bleeding
A regular, constant, and urgent need to defecate even when there is nothing to actually pass (also known as Tenesmus)
sudden weight loss
malnutrition
anemia
Osteoporosis and bone health
The intensity of these symptoms can range from mild to life-threatening.
Inflammatory bowel disease mainly shows up as:
Ulcerative Colitis, which has sores along the lining of the lower digestive tract, such as the colon and rectum, as one of the primary symptoms.
Or Crohn's disease, where the lining of the upper digestive tract (including the mouth and esophagus) is inflamed and damaged. This damage makes it difficult for those organs to do their jobs, so the symptoms vary depending on which organs are the most affected.
IBD and Lupus: How Are They Connected?
1. They are both autoimmune or immune-mediated diseases
Systemic lupus erythematosus (SLE) happens when the immune system attacks healthy tissues throughout the body — skin, joints, kidneys, heart, lungs, brain, and more.
Inflammatory bowel disease (IBD) — which includes Crohn’s disease and ulcerative colitis — happens when the immune system targets the digestive tract.
Because both involve immune system dysfunction and inflammation, they sometimes occur together in the same person.
2. Shared immune pathways and genetic factors
Research shows overlapping immune pathways, such as cytokines (IL-6, TNF-α) and immune cells (T-cells, B-cells), play roles in both lupus and IBD.
Some people may have genetic predispositions that increase risk for multiple autoimmune diseases — a concept known as polyautoimmunity.
Because SLE symptoms can overlap with IBD, especially when lupus affects the guts, it can sometimes be difficult to tell when both are happening in a patient.
The Microbiome, Lupus, and IBD
The gut microbiome is a term used for the colonies of bacteria, viruses, and other microorganisms that live in different parts of our gut. The microbiome is essential for the body in many ways, and you can read more about it, here.
The gut microbiome helps to break down food, produce vitamins (which the body cannot get any other way), regulates metabolism, regulates the immune system, and can even influence how we think!
People with lupus and people with IBD both show changes in their microbiome compositions. Researchers aren’t yet sure why this happens or what it means.
Either way, once the microbiome and the lining of the intestine are damaged, it becomes easier for more inflammation to occur, and the immune system keeps attacking the body. As the symptoms feed into each other, IBD becomes a chronic disease, and it becomes difficult to break free of the cycle.
What about IBS?
Though they have similar symptoms, Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS) are different disorders. IBS is not an autoimmune condition; it results from a more sensitive colon due to inflammation, neurological connections between the brain and the gut, pain, stress, anxiety, or diet. IBS is also less severe, not usually ending up as life-threatening or requiring surgery. Someone with lupus could have IBS, but it wouldn't be treatable by using the same methods.
Instead, IBS is treated with a careful, balanced diet (avoiding trigger foods, eating fiber, and drinking plenty of fluids,) drinking plenty of water, and getting plenty of sleep.
A balanced diet for lupus which can include bone broth (which provides many vitamins, minerals, and collagen,) will also help with IBS. A dietician or nutritionist can help with a balanced diet and finding nutritious foods. You can read more about nutrition here.
Medication-wise, IBS is generally treated with fiber supplements, laxatives, or antidiarrheals, depending on symptoms. Antidepressants, both tricyclic and SSRIs may also be used to help reduce pain, since they have the side effect of blocking the neurons connected to the intestines, relieving pain and constipation.
Treatment for IBD and Lupus
The goal of IBD and Lupus treatment is to reduce the symptoms and, hopefully, enter remission - the absence of symptoms. Neither IBD nor lupus can be fully cured - the symptoms can flare up even after years of nothing. However, freedom from symptoms is important for the health and well-being of people with IBD and lupus, making the treatments well worth it. Both IBD and lupus often respond to immune-suppressing and anti-inflammatory treatments, though specifics vary.
For IBD, treatments may include:
Anti-inflammatory medications (such as corticosteroids or biologics)
Immune-suppressing drugs to reduce overactive immune responses
Lifestyle changes — such as adjusting diet and managing stress
Symptom relief medications, like antidiarrheal drugs or pain relievers
Some antidepressants are also used to help reduce gut pain because they change how nerves in the intestines send signals.
The goal of treatment is to control inflammation, prevent flares, and keep the disease in remission.
Fellow lupus warriors also have their own personal methods for managing their gastrointestinal issues. Some tactics include eating small meals, avoiding meals before bedtime, cutting back on aspirin (an over-the-counter non-steroidal anti-inflammatory that can irritate the lining of the digestive system) and avoiding certain foods.
Living with Lupus and IBD
If you live with lupus and are experiencing ongoing abdominal pain, diarrhea, or other digestive symptoms, you’re not alone. It’s important to talk with your doctor. Keeping a symptom diary may help your care team figure out whether the issue is:
a lupus flare,
inflammatory bowel disease,
or irritable bowel syndrome.
It may take time to sort out the cause, but with the right diagnosis and treatment, many people with IBD and lupus are able to manage symptoms and live full lives.