Gastrointestinal manifestations of vasculitis
- Michael D Apstein, MD
Michael D Apstein, MD
- Assistant Professor of Medicine
- Harvard Medical School
Vasculitis involving the gastrointestinal tract is usually part of a systemic process, although the signs and symptoms may initially be limited. (See "Overview of and approach to the vasculitides in adults".)
This topic review will cover the clinical manifestations and approach to the diagnosis of gastrointestinal vasculitis. The individual disorders, such as polyarteritis nodosa (PAN) and systemic lupus erythematosus (SLE), are discussed in detail elsewhere, as are systemic vasculitides without prominent gastrointestinal manifestations, such as granulomatosis with polyangiitis (Wegener’s) and mixed cryoglobulinemia. The latter disorder is of interest to gastroenterologists because it usually represents an extrahepatic manifestation of hepatitis C virus infection. (See "Clinical manifestations and diagnosis of polyarteritis nodosa in adults" and "Gastrointestinal manifestations of systemic lupus erythematosus" and "Clinical manifestations and diagnosis of granulomatosis with polyangiitis and microscopic polyangiitis" and "Clinical manifestations and diagnosis of the mixed cryoglobulinemia syndrome (essential mixed cryoglobulinemia)".)
The signs and symptoms of systemic vasculitis involving the gastrointestinal tract result from mesenteric ischemia and/or ischemic colitis. The presentation of patients with ischemic colitis secondary to vasculitis is similar to that of patients with ischemic colitis from other etiologies in that both present with rectal bleeding. In contrast to patients with chronic mesenteric ischemia due to a low flow state, who usually give a history of chronic abdominal pain, patients with vasculitis involving the gastrointestinal tract may present with acute abdominal pain. Similar to patients with chronic mesenteric ischemia, these patients frequently have pain that is out of proportion with findings on abdominal exam before intestinal infarction occurs. Clinicians should consider gastrointestinal vasculitis in this setting in the absence of a source of embolization. (See "Overview of intestinal ischemia in adults" and "Chronic mesenteric ischemia".)
In three series with a total of 351 patients, approximately one-third had gastrointestinal manifestations [1-3]. In one large series of patients with polyarteritis nodosa (PAN) or eosinophilic granulomatosis with polyangiitis (EGPA; Churg-Strauss), for example, the following frequency of gastrointestinal symptoms and findings was noted :
●Abdominal pain – 25 percent
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- SPECIFIC DISORDERS
- Polyarteritis nodosa
- Eosinophilic granulomatosis with polyangiitis
- Henoch-Schönlein purpura (IgA vasculitis)
- Systemic lupus erythematosus
- - Antiphospholipid syndrome
- Rheumatoid vasculitis
- Behçet's syndrome
- Inflammatory bowel disease associated vasculitis
- Takayasu arteritis
- Jejunal vasculitis
- Drug-induced vasculitis
- EVALUATION OF THE PATIENT
- Imaging studies
- SUMMARY AND RECOMMENDATIONS