Gastrointestinal involvement in childhood vasculitides

Abstract

Aim: The aim of this narrative review was to provide a comprehensive summary of the characteristics of gastrointestinal (GI) involvement in the most common paediatric primary vasculitides. Methods: We used PubMed to primarily identify papers, reviews, case series and editorials published in English from 2000 until 31 January 2020. Based on this, we report the prevalence, clinical manifestations, diagnostic approaches and management of GI involvement in each vasculitis. Results: Vasculitides are inflammatory blood vessel diseases, and the majority can affect the GI system with vascular, GI tract or solid organ involvement. GI involvement can sometimes complicate and delay the correct diagnosis. Clinical findings are usually nonspecific symptoms, such as fever, abdominal pain, nausea, vomiting and diarrhoea. Bleeding should alert paediatricians to the possibility of severe complicated vasculitis. Diagnosis relies mostly on imaging. If it goes unrecognised, GI involvement in paediatric vasculitis is a serious cause of morbidity and even mortality, related to bowel ischaemia and perforation. Treatment of GI symptoms depends on the type of vasculitis and usually involves high-dose steroids and immunosuppressants. Conclusion: GI manifestations in the most common paediatric primary vasculitides were usually nonspecific, diagnosis mostly relied on imaging, and treatment usually involved high-dose corticosteroids and immunosuppressants. K E Y W O R D S childhood, gastrointestinal involvement, immunosuppressant, steroids, vasculitis | 2227 TRAPANI eT Al. paralytic ileus, mesenteric ischaemia, bowel obstruction and perforation. Occasionally, GI involvement can be the presenting feature, and this can complicate and delay the correct diagnosis. The aim of this narrative review was to provide a comprehensive summary and update of the characteristics of GI involvement in the most common paediatric primary vasculitis. 2 | ME THODS We used PubMed to primarily identify papers, reviews, case series and editorials published in English from 2000 until 31 January 2020. The keywords included the following: IgA vasculitis, Henoch-Schonlein purpura, Kawasaki disease, Behcet disease, polyarteritis nodosa, Takayasu arteritis, deficiency of adenosine deaminase 2, antineutrophilic cytoplasmic antibodies-associated vasculitis, gastrointestinal, gut, child and paediatric or paediatric.

Terminal ileitis: a rare gastrointestinal manifestation of IgA vasculitis in a child

“…GI symptoms include abdominal pain, vomiting, bleeding and diarrhoea 3 6 7. Abdominal pain is usually colicky in nature, worse after eating, mimicking bowel angina or ischaemia 8. GI complications associated with IgA vasculitis such as intussusception, GI haemorrhage, ileal perforation, stricture and protein-losing enteropathy are encountered only in 5% of patients 4.…”

“…GI complications associated with IgA vasculitis such as intussusception, GI haemorrhage, ileal perforation, stricture and protein-losing enteropathy are encountered only in 5% of patients 4. GI symptoms of IgA vasculitis are due to IgA deposits on small vessel walls causing a vasculitis involving the splanchnic circulation which causes oedema and submucosal haemorrhages 2 8. The most common site of gut involvement is the second part of the duodenum 2 7.…”

“…The outcome for IgA vasculitis is usually good with over 80% making a recovery within 2 weeks 8. IgA vasculitis is a self-limiting condition, and treatment in the majority of cases is symptomatic.…”

“…Steroids can reduce the length of hospital stay in cases with severe abdominal pain 2. However, there is inconclusive evidence as to whether steroids reduce the risk of relapse 8. Steroids decrease intestinal wall oedema and therefore reduce the GI symptoms which can take up to 2 weeks to resolve without steroids 2.…”

Immunological Features of Children with Gastrointestinal Bleeding Due to Henoch-Schönlein Purpura

“…1,2 The reported incidence varied from 3 to 27 per 100,000 children, and the incidence could reach 56 per 100,000 Asian children with a peak incidence of five years. 3,4 The clinical features of HSP include non-thrombocytopenic purpura, arthritis, arthralgia, gastrointestinal (GI) disorders, and renal involvement. 1 About two-thirds of children with HSP have abdominal pain with or without abdominal distension, nausea, vomiting, and GI bleeding.…”