Gastrointestinal involvement in Henoch-Schönlein purpura

Objective. To analyse the gastrointestinal manifestation of Henoch-Schönlein purpura (HSP) in adult patients, including clinical and endoscopic features. Material and methods. Patients with a final diagnosis of HSP admitted from January 1995 to January 2006 were included. Their medical records, including clinical presentation, laboratory data, endoscopy and pathology reports, were reviewed retrospectively. Results. One-hundred-and-fifteen patients were included. Gastrointestinal symptoms occurred in 90 patients (78.2%), with abdominal pain the most common symptom. Fifty-four patients underwent gastroscopy, while 24 underwent colonoscopy. The endoscopic lesions included mucosal erythema, oedema, multiple irregular ulcers and nodular changes. In the upper GI tract, the second portion of the duodenum was the most frequently involved area and is where the most severe lesions occur. In the lower GI tract, the rectum was the most frequently involved area, but the most severe lesions were found in the terminal ileum. Conclusions. HSP may present with acute abdomen without typical skin manifestations, and gastroscopy and colonoscopy can be helpful in the early diagnosis of HSP in these patients. Typical endoscopic findings include diffuse mucosal oedema, erythema, petechia or multiple irregular ulcers, especially in the second portion of the duodenum or in the terminal ileum.