Diseases of the Gallbladder and the Biliary Tree in Systemic Lupus Erythematosus: Review of Clinical Presentation, Diagnosis and Management

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Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterised by multi-system involvement and diverse clinical manifestations. Among the systems affected, the gastrointestinal and hepatobiliary systems are notable taragets of the autoimmune response. Although gastrointestinal and hepatic syndromes commonly reported, gallbladder dysfunction is rare and not included in the diagnostic criteria for the disease. Biliary complications in SLE can present as a spectrum of conditions, ranging from acalculous cholecystitis and Salmonella infection to more uncommon manifestations such as primary biliary cirrhosis, autoimmune cholangiopathy, and primary sclerosing cholangitis. These complications frequently occur in the context of heightened lupus disease activity, with vasculitis identified as a key underlying mechanism, and are associated with significant morbidity. Thus, biliary involvement should be considered in the differential diagnosis of abdominal pain and related symptoms in patients with SLE. This review article explores the spectrum of gall bladder and the biliary manifestations in SLE and discusses the corresponding diagnostic and treatment strategies.