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Overview of gastrointestinal manifestations of vasculitis

Author
Michael D Apstein, MD
Section Editor
Peter A Merkel, MD, MPH
Deputy Editors
Monica Ramirez Curtis, MD, MPH
Shilpa Grover, MD, MPH, AGAF

INTRODUCTION

The vasculitides are defined by the presence of inflammatory leukocytes in vessel walls with reactive damage to mural structures. Symptomatic involvement of the gastrointestinal tract may occur either in isolation or in combination with multiple organs. Vasculitis should be considered in patients when the history, physical exam, laboratory, and/or radiologic data indicate that multiple organ systems are involved. However, the diagnosis may be confirmed only after pathologic examination of excised tissue due to ischemia, infarction, or perforation of the involved portion of the gastrointestinal tract.

This topic will review the clinical features and evaluation of patients with gastrointestinal vasculitis. The major vasculitides that may present with gastrointestinal involvement are also described. The diagnosis and treatment of major vasculitides are discussed in detail separately. (See "Overview of and approach to the vasculitides in adults" and "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)".)

EPIDEMIOLOGY

While several vasculitides may be associated with gastrointestinal involvement, it is most prevalent in patients with immunoglobulin A vasculitis (Henoch-Schönlein purpura), antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis, polyarteritis nodosa (PAN), and Behçet's syndrome [1]. In three series with a total of 351 patients with systemic vasculitis, approximately one-third had gastrointestinal manifestations [2-4].

MAJOR VASCULITIDES WITH GASTROINTESTINAL INVOLVEMENT

The frequency and type of gastrointestinal manifestations vary among the vasculitides. Symptoms of vasculitis involving the gastrointestinal tract result from ischemia to the affected organ. Although vasculitis is frequently classified by the size of the vessels involved, the symptoms from either large-, medium-, or small-vessel vasculitis can overlap. As such, abdominal pain, nausea, vomiting, diarrhea, and/or gross or occult blood in the stool is common. Gross bleeding is more commonly seen in vasculitis involving the colon compared with that involving the small bowel, but there is considerable overlap of symptoms so it is difficult to determine clinically which portion of the gastrointestinal tract is involved.

The major vasculitides with gastrointestinal involvement are discussed below, using the international Chapel Hill Consensus Conference (CHCC) classification categories. (See "Overview of and approach to the vasculitides in adults".)

                         
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Literature review current through: Oct 2017. | This topic last updated: Oct 31, 2017.
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