Clinical Characteristics and Outcome of Gastrointestinal Involvement of Henoch-Sch(o)nlein Purpura: Analysis of 35 Cases / 胃肠病学

ABSTRACT

Background: Gastrointestinal involvement of Henoch-Sch(o)nlein purpura (HSP) lacks specific clinical manifestations, which makes it difficult to be diagnosed and easy to misdiagnose.Aims: To analyze the clinical characteristics and outcome of gastrointestinal involved HSP across all ages and provide evidence for early diagnosis and treatment of the disease.Methods: A retrospective analysis was conducted on 35 gastrointestinal involved HSP patients admitted to Shanghai Changzheng Hospital from Jan.2006 to Jan.2016.The clinical outcome was followed up by phone interview.Results: Of the 35 gastrointestinal involved HSP patients, 22 were male and 13 were female, with a mean age of disease onset at 33.6 years.The frequent disease onset seasons were winter and spring, and the most frequent precipitating events were eating foreign proteins and upper respiratory tract infection shortly before disease onset.Abdominal pain was the presenting manifestation in 35 patients (57.1%) and was most frequently at periumbilical area (42.9%), and 48.6% of the pain was of paroxysmal colicky pain.The abdominal signs were mild.Laboratory tests showed 57.1% of the patients had elevated leukocyte count and 25.0% had elevated serum IgA.Stomach, duodenum, rectum and colon were frequently involved endoscopically, and the endoscopic lesions included mucosal petechia, diffuse mucosal erythema, edema and erosion.Nonspecific inflammatory cells infiltration was demonstrated by biopsy pathology.The overall prognosis was good with a recurrence rate of 21.9%.Elevated serum fibrinogen degradation product (FDP) and D-dimer were found in all the recurrent patients at admission.Conclusions: Purpura rash usually appeared later than gastrointestinal symptoms in gastrointestinal involved HSP.Typical clinical manifestations and endoscopic appearances are helpful for early diagnosis and treatment.Elevated FDP and D-dimer might be the predictor of recurrence.