“I’m having diarrhea and stomach pain/cramping right now,” one MyLupusTeam member wrote. “Could this be pancreatitis or diverticulitis?” When someone with lupus also has other health conditions, it becomes challenging to determine where certain symptoms are coming from. Lupus can have an impact on any organ of the body and can frequently affect the gastrointestinal tract. When lupus affects the gastrointestinal tract, it can lead to conditions like pancreatitis, liver diseases, diverticulitis, and mesenteric vasculitis (a disorder of the vessels of the gastrointestinal tract).

Many people with lupus often experience a common digestive problem called diverticulitis.

In diverticulitis, weak spots in the intestines become infected and inflamed, causing pain, bloody stools, and other complications. Lupus itself doesn’t directly cause diverticulitis. However, some lupus medications may cause an increased risk of diverticulitis or related complications:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids (like prednisone)
• Immunosuppressants (medications that weaken the immune system to help reduce inflammation)

These complications may include bowel perforations or sepsis, a severe infection that can lead to organ failure and serious health consequences.

Pancreatitis, a rare complication of lupus, is a completely different condition in which your pancreas is inflamed. Pancreatitis can be caused not only by lupus itself but also by the treatments used for managing the condition. Certain medications used in lupus treatment, such as azathioprine (Imuran) and steroids, can increase the likelihood of developing pancreatitis. Doctors diagnose pancreatitis when blood tests show a spike in pancreatic enzymes. Some studies suggest that 30.5 percent of people with lupus have elevated pancreatic enzymes at any given time.

There are some similarities between these conditions and lupus — for instance, they all involve inflammation and may affect the gastrointestinal system. However, diverticulitis and pancreatitis aren’t the same and don’t require the same form of treatment. Considering the nature of your pain and accompanying symptoms, here are some factors that may help identify the potential causes of your stomach issues.

1. Where You Feel Pain

Diverticulitis affects the intestines, and pancreatitis affects the pancreas. These organs are in similar areas of the body. However, diverticulitis usually causes pain in the lower left side of the abdomen. Pancreatitis pain affects the upper abdomen and sometimes spreads to the back.

One MyLupusTeam member shared their experience with pancreatitis. “I’ve had pancreatitis, and it’s very painful,” they said. “My stomach and back were hurting so badly that I had to go to the emergency room. I didn’t have diarrhea.”

2. When You Feel Pain

In diverticulitis, the pain is ongoing and persistent. It may last several days until the issue resolves itself or until you seek treatment. A MyLupusTeam member shared a scary experience with the sudden onset of diverticulitis: “I was at work and got incredible stomach pains, which I figured were from cramps or a pulled muscle because of my work. The following day, I was doubled over in sheer pain. My wife phoned our GP, and he thought it was my appendix. They rushed me to the hospital, and it turned out to be a very long lifesaving surgery. They discovered I had diverticular disease, and my bowel was very badly infected, perforated, and about to burst.”

Pancreatitis pain tends to change based on what you ate and your position. For example, you’re more likely to feel pancreatitis pain after eating or when you touch your abdomen, lie flat, cough, or exercise. Pain from pancreatitis may improve when you sit upright, lean forward, or curl into a ball.

3. Which Other Symptoms Accompany Pain

Other symptoms of diverticulitis and pancreatitis may help you figure out the cause of your pain more easily. Nausea and vomiting are common symptoms in both conditions, as is having a fever or experiencing burning sensations. These are also common symptoms of lupus, but you should always discuss sudden changes or an increased severity with your doctor to see if another issue is to blame.

With diverticulitis, you may also experience:

• Constipation
• Distended abdomen (bloating)
• Rectal bleeding, bloody stools

Symptoms more unique to pancreatitis include:

• Indigestion
• Light-headedness from low blood pressure
• Poor appetite
• Rapid heart rate
• Shallow breathing
• Stool with fat it in (an oily film after having a bowel movement)
• Unexpected weight loss

One MyLupusTeam member described their bout of pancreatitis: “When I had pancreatitis, I couldn’t eat or hold anything down. I had never been through so much pain in my life. I stayed in the hospital for about a month the first time. That was a few years ago, but I had it again recently and had to stay two weeks until I got better and could finally eat something.”

Getting the Right Diagnosis

To help your doctor figure out what’s going on, one MyLupusTeam member suggested answering these questions. Bring this list and your answers with you to the doctor’s appointment.

1. What are your symptoms like?

2. When did they start?

3. How long do they last?

4. What makes them feel better?

5. What makes them feel worse?

6. Have you noticed anything that triggers the symptoms?

7. On a scale of 1 to 10, how much do these symptoms interfere with your activities of daily living, and how?

Paying attention to your symptoms gives your health care provider valuable insight when deciding what to do next.

Your doctor can use imaging and blood tests to find out why you’re experiencing pain. If you have diverticulitis, your provider may be able to spot pouches or inflamed areas of the intestines on a CT scan. They may also perform a colonoscopy to check the large intestine. A colonoscopy is a medical procedure in which a flexible tube with a camera is inserted into the rectum to examine its lining and look for any abnormalities or diseases. Testing the blood, urine, and stool can also help pinpoint a diverticulitis diagnosis.

Amylase and lipase are enzymes produced by the body that help with the digestion of food. Pancreatitis causes a spike in amylase and lipase, which can be seen with a blood test. Your doctor may also use a CT scan or MRI to look for swelling in the pancreas.

There are many potential causes of similar gastrointestinal symptoms, such as inflammatory bowel diseases like ulcerative colitis and Crohn’s disease, liver disease, peptic ulcers/heartburn, gallstones, vasculitis, peritonitis, and celiac disease. While it’s helpful to hear about the experiences of others, remember that people don’t always feel pain in the same way.

You should rely on your rheumatology provider for an accurate diagnosis and treatment. Remember that diverticulitis and pancreatitis can be life-threatening if you develop dangerous complications.

One member shared words of caution: “Please watch your diverticulitis carefully. I ended up in the hospital for 11 days from severe diverticulitis that perforated. I had to have an ileostomy surgery. I have a low immune system because I have to take biologics, and I don’t think I was on antibiotics long enough to heal the diverticulitis flare.”

Keep yourself safe by never ignoring or underestimating severe abdominal pain. If you get treatment for your condition and the symptoms continue, be sure to follow up for another evaluation.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 223,000 people with lupus come together to ask questions, give advice, and share their stories.

Have you experienced severe abdominal pain from diverticulitis, pancreatitis, or another digestive tract problem? What other symptoms did you have? Post your thoughts in the comments below, or start a conversation by sharing on your Activities page.