Vasculitides of the gastrointestinal tract
ABSTRACT Systemic vasculitis is often not considered as a possible diagnosis by clinicians because of its low prevalence compared with other more common diseases. Vasculitis can affect any end organ, and it is therefore often missed early on in disease progression. Gastrointestinal (GI) manifestations of vasculitis are considered rare and the presentation is often nonspecific. However, if there is significant involvement of the major vessels of the gastrointestinal system, life-threatening sequelae, including perforation and bowel ischemia, may occur. This makes early and immediate management crucial to improve long-term morbidity and mortality. Diagnosis of various GI vasculitides often relies on correlation of clinical manifestations with pathology and additional investigations. This paper reviews the various vasculitides that affect the GI tract, including systemic lupus erythematosus, mixed connective tissue disease, Henoch Schönlein purpura, polyarteritis nodosa, Churg-Strauss syndrome, Wegener's granulomatosis, microscopic polyangiitis, enterocolic lymphocytic phlebitis, and Behcet's disease. Segmental arterial mediolysis, mistakenly believed to be a vasculitis, is also discussed.
- SourceAvailable from: Awad Ali Mohamed Ahmed Alawad[Show abstract] [Hide abstract]
ABSTRACT: Polyarteritis nodosa is a form of vasculitis that affects several organs. Gastrointestinal involvement is frequent, but cases in which the gastrointestinal tract is the only site of disease are rare. In this paper, we report a case of a 40 -year- old patient with polyarteritis nodosa restricted to small part of the small intestine, which underwent resection and anastomosis. Laparotomy was performed despite normal radiological findings. He underwent resection of the infracted segment. Histopathological examination confirmed the diagnosis. Thus, a pathological diagnosis of ischaemic infarction due to polyarteritis Nodosa (PAN) was made. The patient had no other signs of chronic vasculitis and for this reason surgical treatment resolved the clinical symptoms.
- Digestive Diseases and Sciences 09/2003; 48(8):1582-99. DOI:10.1023/A:1024776125966 · 2.55 Impact Factor
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ABSTRACT: Objective To evaluate the clinical characteristics of lupus mesenteric vasculitis (LMV) and identify the potential factors and appropriate treatments that are associated with disease relapse and prognosis inLMV. Methods A retrospective cohort study was performed among patients admitted to the 1st Affiliated Hospital of Sun Yet-sen University between 2002 and 2011. Demographic information, clinical symptoms, laboratory findings, imaging characteristics like abdominal CT scan, ultrasonography, medications including corticosteroid, cyclophosphamide and other immunosuppressive agents, and outcomes were documented. The endpoints of the study were defined as occurrence of severe complications which needed surgical intervention, disease recurrence, or death. Results Ninty-seven out of 3823 systemic lupus erythematosus (SLE) patients were diagnosed as mesenteric vasculitis with the overall prevalence of 2.5%. Among these 97 LMV patients, 13 died because of serious complications (13/97, 13.4%) and 2 presented intestinal perforation during the induction therapy stage. The logistic regression multivariate analysis indicated that leucopenia [peripheral WBC，odds ratio (OR) = 0.640，95% confidence interval (CI ) 0.456~0.896，P =0.009], hypoalbuminemia (serum albumin，OR= 0.891，95% CI 0.798~0.994，P =0.039) and elevated serum amylase (OR=7.719，95% CI 1.795~33.185，P =0.006) were positively associated with the occurrence of serious complications, while intravenous cyclophosphamide (CYC) therapy inhibited the occurrence of serious complications (OR= 0.220, 95%CI 0.053~0.903, P =0.036). Seventy-nine patients who achieved remission were followed-up for 2 to 96 months and 18 cases experienced disease relapse (18/79, 22.8%). The statistical analysis adjusted by Cox proportional hazards models indicated that, high dose CYC therapy (≥1.0 g/m2 per month) was a protective factor for disease relapse and led to better outcomes [hazard ratio (HR)=0.209, 95% CI 0.049~0.887, P =0.034], while the severe thickness of the bowel wall (>8 mm) was a risk factor (HR=7.308, 95%CI 1.740~ 30.696, P =0.007). LMV and lupus cystitis occurred concurrently in 22 (22.7%, 22/97) patients, and the symptoms of urinary tract resolved after treated with corticosteroid and immunosupressants. Conclusion LMV is one of the serious complications of SLE with high mortality. The current study demonstrated that leukopenia, hypoalbuminemia and elevated serum amylase were associated with severe adverse events, while CYC therapy led to better outcomes during remission-induction stage. Severe thickness of the bowel was a risk factor while high dose CYC therapy was a protective factor for disease relapse in intensification therapy stage. It’s necessary to evaluate the urinary tract involvement once LMV was diagnosed due to the frequent coexistence of these two diseases.Seminars in arthritis and rheumatism 01/2013; DOI:10.1016/j.semarthrit.2013.11.005 · 3.63 Impact Factor