Intermittent abdominal pain in IgA vasculitis

Abstract

Objective: To assess intermittent abdominal pain in IgA vasculitis patients and its relation to demographic data, clinical manifestations and treatments. Methods: A retrospective cohort study included 322 patients with IgA vasculitis (EULAR/PRINTO/PRES criteria) seen at the Pediatric Rheumatology Unit in the last 32 years. Sixteen patients were excluded due to incomplete data in medical charts. Intermittent abdominal pain was characterized by new abdominal pain after complete resolution in the first month of disease. Results: Intermittent abdominal pain was observed in 35/306 (11%) IgA vasculitis patients. The median time between first and second abdominal pain was 10 days (3–30 days). The main treatment of intermittent abdominal pain included glucocorticoid [n=26/35 (74%)] and/or ranitidine [n=22/35 (63%)]. Additional analysis showed that the frequency of intermittent purpura/petechiae (37 vs. 21%; p=0.027) and the median of purpura/petechiae duration [20 (3–90) vs. 14 (1–270) days; p=0.014] were significantly higher in IgA vasculitis patients with intermittent abdominal pain compared to those without. Gastrointestinal bleeding (49 vs. 13%; p<0.001), nephritis (71 vs. 45%; p=0.006), glucocorticoid (74 vs. 44%; p=0.001) and intravenous immunoglobulin use (6 vs. 0%; p=0.036) were also significantly higher in the former group. The frequency of ranitidine use was significantly higher in IgA vasculitis patients with intermittent abdominal pain versus without (63 vs. 28%; p<0.001), whereas the median of ranitidine duration was reduced in the former group [35 (2–90) vs. 60 (5–425) days; p=0.004]. Conclusions: Intermittent abdominal pain occurred in nearly a tenth of IgA vasculitis patients, in the first 30 days of disease, and was associated with other severe clinical features. Therefore, this study suggests that these patients should be followed strictly with clinical and laboratorial assessment, particularly during the first month of disease course.

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

“…These patients should be followed up strictly with clinical and laboratory assessments, mainly during the first month of the disease course. 21 There are inconsistent results in the literature regarding serum IgA, IgG, and IgM levels in children with HSP. Patients with HSP could have immune disorders outside the IgA compartment, and there could be interactions between IgA and other Igs, likely contributing to the higher likelihood of complications.…”

Serum Syndecan-1 levels in patients with immunoglobulin A vasculitis in children

“…Abdominal symptoms occur in 75% of patients with IgAV, 6 and 11% IgAV patients may be presented with intermittent abdominal pain in the first 30 days of disease. 7 Moreover, complications can mimic acute abdomen conditions, including perforations, intussusception, and bowel infarctions that can be fatal without timely surgical procedures. 6 Thus, timely diagnosis and intervention therapy are essential to improve the prognosis of patients with IgAV.…”