Korean J Pediatr Gastroenterol Nutr.  2011 Dec;14(4):359-367. 10.5223/kjpgn.2011.14.4.359.

Comparison of the Clinical Manifestations and Prognosis of Henoch-Schonlein Purpura in Children with and without Abdominal Pain

• Kim S
• Yoon J
• Jeong S

• KMID: 2277707
• DOI: http://doi.org/10.5223/kjpgn.2011.14.4.359

Abstract

PURPOSE
We compared the clinical manifestations and prognosis of Henoch-Schonlein Purpura (HSP) in children with and without abdominal pain to investigate the usefulness of endoscopy.
METHODS
We retrospectively studied 185 HSP inpatients (group A [with abdominal pain] and group N [without abdominal pain]) who had been admitted to the BundangCHA hospital between 2001 and 2010. We compared clinical manifestations, laboratory findings and endoscopic and ultrasonographic findings.
RESULTS
Of the 185 children, 112 (60.5%) had abdominal pain and 31 (16.8%) presented with abdominal pain before developing cutaneous purpura. Group A patients were older (6.9+/-3.5 vs. 5.3+/-3.3 years), had higher rates of positive results for stool occult blood (53.8%, p<0.001), and had longer hospital stays (5.2+/-4.2 vs. 3.6+/-2.5 days) than group N patients. Group A had a higher frequency of renal involvement than group N on admission (p=0.047). Ultrasonography showed small bowel wall thickening in 31 cases (43.7%) and increased Doppler flow in the bowel wall in 22 cases (31%) in Group A. Upper gastrointestinal endoscopy revealed HSP - related lesions in the stomach (25 cases) and duodenum (19 cases). The second portion of the duodenum was a more common lesion site than the duodenal bulb. Ultrasonography showed abnormalities in 13 of 19 patients with duodenal lesions. Recurrence was more common in Group A.
CONCLUSION
These results suggest that recurrence and renal involvement are more common in HSP patients with abdominal pain. Upper gastrointestinal endoscopy could be a useful diagnostic tool for HSP patients who develop abdominal pain before cutaneous purpura.

Keyword

Henoch-Schonlein Purpura; Ultrasonography; Endoscopy; Abdominal pain

MeSH Terms

Abdominal Pain
Child
Duodenum
Endoscopy
Endoscopy, Gastrointestinal
Humans
Inpatients
Length of Stay
Occult Blood
Prognosis
Purpura
Purpura, Schoenlein-Henoch
Recurrence
Retrospective Studies
Stomach

Figure

• 

  Fig. 1 The incidence of abnormal findings on upper gastrointestinal endoscopy in patients with HSP. A1: HSP with abdominal pain before cutaneous purpura in group A, A2: HSP with purpura before abdominal pain in group A, Eso: esophagus, St: stomach, D. bulb: duodenal bulb, D. 2nd: duodenal second portion.

Reference

1. Gardner-Medwin JMM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch-Schonlein Purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet. 2002. 360:1197–1202.

2. Tizard EJ. Henoch-Schonlein purpura. Current Paediatrics. 2002. 12:575–580.

3. Rostoker G. Schonlein-Henoch purpura in children and adult: diagnosis, pathophysiology and management. BioDrugs. 2001. 15:99–138.

4. Tomomasa T, Hsu JY, Itoh K, Kuroume T. Endoscopic findings in pediatric patients with Henoch-Schonlein Purpura and gastrointestinal symptoms. J Pediatr Gastroenterol Nutr. 1987. 6:725–729.

5. Trapani S, Micheli A, Grisolia F, Resti M, Chiappini E, Falcini F, et al. Henoch-Schonlein Purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum. 2005. 35:143–153.

6. Hung SP, Yang YH, Lin YT, Lee JH, Chiang BL. Clinical manifestations and outcomes of Henoch-Schonlein Purpura: Comparison between adults and children. Pediatr Neonatol. 2009. 50:162–168.

7. Choong CK, Beasley SW. Intra-abdominal manifestation of Henoch-Schonlein Purpura. J Paediatr Child Health. 1998. 34:405–409.

8. Oh SW, Choe JH, Kim YJ. A study of clinical manifestation of gastrointestinal symptoms in children with Henoch-Schonlein Purpura. Korean J Pediatr Gastroenterol Nutr. 2006. 9:183–192.

9. Chang JY, Kim YJ, Kim KS, Kim HJ, Seo JK. Henoch-Schonlein Purpura presenting with acute abdominal pain preceding skin rash: review of 23 case. J Korean Pediatr Soc. 2003. 46:576–584.

10. Katz S, Borst M, Seekri I, Grosfeld JL. Surgical evaluation of Henoch-Schönlein Purpura. Experience with 110 children. Arch Surg. 1991. 126:849–853.

11. Miler ML, Pachman LM. Behrman RE, Kliegman RM, Jenson HB, editors. Henoch-Schonlein Purpura. Nelson textbook of pediatrics. 2007. 18th ed. Philadelphia: WB saunders Co.;1043–1045.

12. Lee DH, Park CH, Park JM, Park GS, Kim HS, Kang CM. Endoscopic findings of children with Henochscholein Purpura. J Korean Pediatr Soc. 2003. 46:572–575.

13. Hong JH, Na HJ, Namgoong HK, Cho SO, Han BG, Jung SH, et al. Different clinical course of Henoch-Schonlein Purpura in children, adolescents and adults. Korean J Pediatr. 2005. 48:1244–1251.

14. Park SH, Nam YN, Park SH, Sim SY, Eun BW, Choi DY, et al. Clinical characteristics of childhood Henoch-Schonlein Purpura with duodenal involvement by upper gastrointestinal endoscopy. Korean J Pediatr Gastroenterol Nutr. 2009. 12:156–162.

15. Noh YI, Ryu MR, Jung CZ, Lee DJ, Kwon JH. Intestinal ultrasonographic and endoscopic findings in pediatric patients with Henoch-Schonlein Purpura and gastrointestinal symptoms. Korean J Pediatr Gastroenterol Nutr. 2001. 4:181–191.

16. Nchimi A, Jamil K, Isabelle P, Francoise B, Paul M. Significance of bowel wall abnormalities at ultrasound in Henoch-Schonlein Purpura. J Pediatr Gastroenterol Nutr. 2008. 46:48–53.

17. Couture A, Veyrac C, Baud C, Galifer RB, Armelin I. Evaluation of abdominal pain in Henoch-Schonlein syndrome by high frequency ultrasound. Pediatr Radiol. 1992. 22:12–17.

18. Shirahama M, Umeno Y, Tomimasu R, Dohmen K, Miyamoto Y, Shimoda Y, et al. The value of colour Doppler ultrasonography of small bowel involvement of adult Henoch-Schönlein Purpura. Br J Radiol. 1998. 71:788–791.

19. Nishiyama R, Nakajima N, Ogihara A, Oota S, Kobayashi S, Yokoyama K, et al. Endoscopic images of Schönlein-Henoch Pupura. Digestion. 2008. 77:236–241.

20. Fagbemi AAO, Torrente F, Hilson AJW, Thomson MA, Heuschkel RB, Murch SH. Massive gastrointestinal haemorrhage in isolated intestinal Henoch-Schonlein Purpura with response to intravenous immunoglobulin infusion. Eur J Pediatr. 2007. 166:915–919.

21. Gunasekaran TS, Derman J, Gonzales M. Duodenojejunitis: Is it idiopathic of is it Henoch-Schonlein Purpura without the purpura? J Pediatr Gastroenterol Nutr. 2000. 30:22–28.

22. Kim MS, Kim HS, Park SJ, Baik SK, Lee DK, Kwon SO, et al. Ileocolonoscopic diagnosis of ileal vasculitis in Henoch-Schonlein Purpura mimicking acute abdomen prior to the development of skin Lesions. Korean J Gastroenterol. 2001. 37:379–383.

23. Kaku Y, Nohara K, Honda S. Renal involvement in Henoch-Schönlein Purpura: A multivariate analysis of prognostic factors. Kidney Int. 1998. 53:1755–1759.

24. Jeoung MJ, Yim HE, Yoo KH, Hong YS, Lee JW, Kim SK. A Multivariate analysis of risk factors of renal involvement in Henoch-Schönlein Purpura. Korean J Pediatr. 2004. 47:405–411.

25. Linskey KR, Daniela K, Martin CM, Mai PH. Immunoglobulin-A-associated small-vessel vasculitis: A 10-year experience at the Massachusetts General Hospital. J Am Acad Dermatol. 2011. Available from http://dx.doi.org/10.1016/j.jaad.2011.06.012.

26. Davin JC, Weening JJ. Diagnosis of Henoch-Schonlein Purpura: renal or skin biopsy? Pediatr Nephrol. 2003. 18:1201–1203.