GASTROINTESTINAL MANIFESTATIONS OF SYSTEMIC VASCULITIS

  • 1 January 1983
    • journal article
    • research article
    • Vol. 52  (206) , 141-149
Abstract
Systemic vasculitis is known to affect the gastrointestinal tract but the nature of the complication is poorly characterized. Out of 65 patients with systemic vasculitis, the majority of whom had renal disease, the intestine was found to be affected in 18. These comprised 4 of 8 patients with polyarteritis nodosa, nine of seventeen with microscopic polyarteritis, four of thirty-six with Wegener''s granulomatosis and one of four with Churg-Strauss syndrome. The features included abdominal pain (85%), diarrhea (50%), gut hemorrhage (44%) and abnormal liver function tests (50%). Manifestations of gastrointestinal disease were evident at presentation in 1/2 of the patients and led to a fatal outcome in 5. Ileus, mucosal abnormalities, perforation and slow transit were evident radiographically, and selective visceral angiography showed aneurysms or organ infarcts in 5 patients. Histological assessment of gut biopsies (chiefly rectal) revealed non-specific inflammation or ulceration in nine patients and intramucosal hemorrhage in 2 patients. Focal areas of necrosis and ulceration in colonoscopic biopsies were highly suggestive of vasculitis whereas arteritis was only found in 1 full thickness biopsy. Hence, the diagnosis of gastrointestinal complications depends largely on clinical evidence. In patients who survived, the gastrointestinal features remitted as the systemic illness improved following treatment with steroids, cyclophosphamide or plasma exchange.