Gastrointestinal endoscopy in Henoch-Schönlein purpura

Kato, Seiichi; Shibuya, Hidenori; Naganuma, Hiroshi; Nakagawa, Hiroshi

doi:10.1007/bf01957748

Cited by 49 publications

(31 citation statements)

References 11 publications

(10 reference statements)

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“…In the present study, however, vasculitis in the mucosa was not shown in any patient. Several studies reported that intestinal IgA deposition in HSP is not always accompanied by vasculitis (4)(5)(6). It remains poorly understood how deposited IgA or IgA immune complexes link to the inflammatory process.…”

Section: Discussionmentioning

confidence: 99%

“…Staining with hematoxylin and eosin was routinely done for light microscopic observation. IgA was examined using the avidin-biotin-complex method (5,6). In two nonrash patients (Patients 4 and 7) and two HSP patients (Patients 11 and 12), biopsy specimens were also fixed in 4% periodatelysine-paraformaldehyde and were studied for immunoreactivities of IgA1 and IgA2, J chain, and secretory component using the indirect immunoperoxidase method (12).…”

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confidence: 99%

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Immunoglobulin A Enteropathy: A Possible Variant of Henoch–Schönlein Purpura

et al. 2004

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This study calls attention to a new syndrome presenting with gastrointestinal symptoms including abdominal pain, vomiting, and/or hematemesis and endoscopic multiple lesions predominantly in the descending duodenum, without the skin rash observed in Henoch-Schonlein purpura. We examined the gastrointestinal mucosa for IgA deposits in nine children and compared the results with those for three patients with Henoch-Schönlein purpura. In addition, gastroduodenal biopsy specimens of 11 patients with various diseases were studied as controls for IgA staining. Intestinal histology showed nonspecific mucosal inflammation without vasculitis. In six patients without rash (67%), IgA deposition was observed in the capillary wall with the same staining pattern as seen in two patients with Henoch-Schonlein purpura. Compared with the controls (9%), the positive rate of IgA deposition was significantly higher in nonrash patients (P < 0.01). Deposited IgA showed immunoreactivities of polymeric IgAl containing J chain. IgA deposits were ultrastructually seen along the plasma membranes of the endothelial cells. Overall, the data suggest that IgA deposition played a pathogenetic role in the gastrointestinal damage in this group of patients presenting primarily with gastrointestinal complaints. Further studies are needed to clarify whether this patient population has a variant of Henoch-Schönlein purpura or a distinct "IgA enteropathy."

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Immunoglobulin A Enteropathy: A Possible Variant of Henoch–Schönlein Purpura

et al. 2004

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“…Vasculitis may be found in the submucosal vessels of the intestine [116] although biopsy of this area risks the possibility of perforation in a disease prone to this complication. The findings in superficial biopsies range from nonspecific inflammation to ulceration, edema, hemorrhage, and vascular congestion, presumably due to vasculitis-induced mucosal ischemia [117]. In one study, LCV was found in those ulcerating lesions that were accompanied by hematoma-like protrusions [65].…”

Section: Diagnosis Of Gi Diseasesmentioning

confidence: 98%

Gastrointestinal Manifestations of Henoch-Schonlein Purpura

2008

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Henoch-Schonlein Purpura (HSP) is the most common systemic vasculitis in childhood. The diagnostic criteria include palpable purpura with at least one other manifestation -- abdominal pain, IgA deposition, arthritis or arthralgia, or renal involvement. Immune complex deposits result in necrosis of the wall of small- and medium-sized arteries with infiltration of tissue by neutrophils and deposition of nuclear fragments, a process called leukocytoclastic vasculitis (LCV). It is often associated with infections, medications, or tumors. It may coexist with or mimic Crohn's disease. Periumbilical and epigastric pain worsens with meals, from bowel angina. Bleeding is usually occult or, less commonly, associated with melena. Intussusception, the most common surgical complication, is usually ileo-ileo or ileo-colic. Perforations, usually ileal, may occur spontaneously or be associated with intussusception. Ultrasound, recommended as the first diagnostic test, and CT scans may show intussusception and asymmetric bowel wall thickening mainly involving the jejunum and ileum. There are a range of endoscopic findings including gastritis, duodenitis, ulceration, and purpura, with the second portion of the duodenum characteristically being involved more than the bulb. Intestinal biopsies show IgA deposition and LCV in the submucosal vessels. Superficial biopsies may show inflammation, ulceration, edema, hemorrhage, and vascular congestion, presumably due to vasculitis-induced mucosal ischemia. The efficacy of corticosteroids in preventing severe complications or relapses is controversial. The majority of patients, however, improve spontaneously.

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“…Kato et al [3] reported endoscopically detected duodenal abnormalities in six of seven HSP children, and in five of these six patients, abnormalities in the second portion of the duodenum were severe. They speculated that the duodenum was the main site of GI inflammation in HSP.…”

Section: Discussionmentioning

confidence: 97%