Gut Liver.
2016 Jul;10(4):542-548. 10.5009/gnl15198.
Endoscopic Findings of Upper Gastrointestinal Involvement in Primary Vasculitis
- Affiliations
-
- 1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. dohoon.md@gmail.com
- 2Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 3Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- KMID: 2412041
- DOI: http://doi.org/10.5009/gnl15198
Abstract
- BACKGROUND/AIMS
Gastrointestinal involvement in vasculitis may result in life-threatening complications. However, its variable clinical presentations and endoscopic features, and the rarity of the disease, often result in delayed diagnosis.
METHODS
Clinical characteristics, endoscopic features, and histopathological findings were reviewed from medical records.
RESULTS
Of 6,477 patients with vasculitis, 148 were diagnosed as primary vasculitis with upper gastrointestinal involvement. Of these, 21 cases (14.2%) were classified as large-vessel vasculitis, 17 cases (11.5%) as medium-vessel vasculitis, and 110 cases (74.3%) as small-vessel vasculitis. According to the specific diagnosis, IgA vasculitis (Henoch-Schönlein purpura) was the most common diagnosis (56.8%), followed by Takayasu arteritis (14.1%), microscopic polyangiitis (10.1%), and polyarteritis nodosa (6.8%). Gastrointestinal symptoms were present in 113 subjects (76.4%), with abdominal pain (78.8%) the most common symptom. Erosion and ulcers were striking endoscopic features, and the second portion of the duodenum was the most frequently involved site. Biopsy specimens were obtained from 124 patients, and only eight (5.4%) presented histopathological signs of vasculitis.
CONCLUSIONS
Diagnosis of vasculitis involving the upper gastrointestinal tract is difficult. Because of the widespread use of endoscopy, combining clinical features with endoscopic findings may facilitate making appropriate diagnoses; however, the diagnostic yield of endoscopic biopsy is low.
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