An Overview of GI Problems In Rheumatoid Arthritis

Rheumatoid arthritis (RA) can cause gastrointestinal (GI) problems. A study reported in the Journal of Rheumatology followed 813 people with RA and 813 people without RA for 10 years. They found that the people with RA had a 70% higher risk of developing an upper GI problem and a 50% greater chance of having a lower GI issue in comparison to others without RA.

Here is what you need to know about GI problems associated with RA, causes, what to look for, and how you can prevent these.

GI Events and RA

The upper GI system runs from the mouth to where the stomach empties into the small intestine. It includes the esophagus, a hollow, muscular tube that carries food and liquids from the throat to the stomach. The lower GI system includes all of the small intestine and large intestine.

• Upper GI events include perforation (a hole in the wall of the GI tract), bleeding, ulcers, obstruction, and esophagitis (inflammation of the esophagus).
• Lower GI events include bleeding, perforation, ulcers, colitis (swelling of the large intestine), and diverticulitis (infection or inflammation of the small sacs that line the intestines).

A study reported in the journal Gastroenterology Research and Practice compared 284 people with RA to 233 people without RA. All study participants were asked questions about upper and lower GI events. The researchers found that upper GI symptoms, including stomach pain, nausea, and feeling full quickly, were common in people with RA compared to others without the condition. They also determined people with RA used laxatives and proton pump inhibitors (drugs to reduce stomach acid) more often.

Causes of GI Problems in RA

Several factors may contribute to GI problems associated with RA, including inflammation, coexisting conditions, gut problems, and medications used to treat RA.

Inflammation

GI conditions are common in inflammatory arthritis and include inflammatory bowel syndrome (IBS), a disorder that may be associated with inflammation of the digestive system. The same inflammatory process that targets your joints can also affect your digestive system.

Coexisting Conditions

RA is associated with other conditions, including conditions affecting the GI tract, like IBS and celiac disease—a disorder in which the immune system overacts to gluten.

Gut Bacteria

Researchers have looked at the connection between stomach bacteria in the GI tract and rheumatic diseases. In addition to the harmless bacteria in your GI system that's normally present, your gut may also have unbalanced bacterial colonies called gut dysbiosis, which is closely linked to inflammatory diseases like RA. Gut dysbiosis is associated with numerous GI troubles and events.

Medications

GI symptoms can be a side effect of some of the medications you take to treat RA, including disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids.

A 2018 study reported by the International Journal of Rheumatic Disease found that people taking 12 milligrams (mg) per week of methotrexate—a DMARD—were more likely to experience acid reflux and abdominal pain than those taking a lower dose of 6 mg per week.

NSAIDs can also irritate the GI tract and are strongly linked to upper GI problems, including ulcers, bleeding, and inflammation of the esophagus.

What To Look Out For

Minor stomach discomfort may not be significant, but if you are having frequent GI issues, this might be a sign of a bigger problem.

GI problems experienced by people with RA may include:

• An ulcer or perforation of the stomach, small intestine, or large intestine
• Inflammation of the esophagus
• Infection and inflammation of the small or large intestine
• Celiac disease—symptoms include diarrhea, fatigue, bloating, gas, stomach pain, constipation, nausea, and vomiting after eating foods containing gluten 

Symptoms associated with GI problems in RA may include:

• Dysphagia—difficulty swallowing
• Abdominal pain
• Indigestion—upper abdominal discomfort that includes a burning sensation, bloating and gas, nausea, or feeling full quickly after starting to eat
• Acid reflux (heartburn)—stomach acid escapes into the esophagus causing inflammation and irritation
• Black, tarry stools from upper GI bleeding
• Bloody stools from lower GI bleeding
• Constipation
• Leaking of stool      
• Diarrhea

Prevention

It is a good idea to be aware of GI symptoms associated with RA and let your healthcare provider know about them, especially if you experience severe abdominal pain and GI bleeding.

You should always follow your healthcare provider’s advice for finding relief from symptoms, which will likely include not smoking, limiting steroid medications and NSAIDs, and taking proton pump inhibitors to reduce symptoms.

If you find certain foods cause you stomach troubles or make your RA symptoms worse, talk to your healthcare provider or a dietitian about how to eliminate those from your diet. 

You will want to avoid foods like:

• Acidic foods including citrus fruits and tomatoes, which may cause discomfort and irritate your stomach lining
• Dairy products if you are lactose intolerant or experience digestive problems after consuming them
• Hot and spicy foods, because they may trigger indigestion and heartburn
• Alcohol, to reduce heartburn and other GI symptoms

A Word From Verywell

If you are experiencing GI symptoms, make an appointment to see your healthcare provider. Make sure you write down your symptoms and try to see if you can identify any triggers. The more information you can provide your healthcare provider, the easier will be for them to determine what is causing your symptoms and how to best manage them.