Background Gastrointestinal involvement can be a challenging complication of systemic vasculitis. It is a relatively common finding in polyarteritis nodosa and IgA realted vasculitis, an infrequent manifestation of ANCA associated vasculitis, and it can rarely manifest as a type of single organ vasculitis.
Objectives To analyze the frequency and types of gastrointestinal (GI) involvement among our patients with systemic vasculitis and report the treatment modalities and outcome in these patients.
Methods Clinical features of all patients with vasculitis who were hospitalized in our department have been prospectively recorded with a standard form between 2000 and 2010. Patients with Behçet's syndrome were not included since they are being recorded in a different database. We identified all vasculitis patients with GI involvement. Information regarding clinical, imaging and histological findings, treatment modalities and prognosis of these patients were obtained from patient charts. Patients who have not visited our department during the last 3 months were invited to the clinic for a final evaluation. Those who were not able to come were interviewed on the phone.
Results A total of 236 patients were hospitalized in our clinic between 2000 and 2010 with a diagnosis of systemic vasculitis. Among these patients we identified 30 (13%) patients with GI involvement (mean age 40.2±17 years, 53% men, mean follow-up duration 56 (1–133) months). The main diagnoses were Takayasu arteritis (10/58, 17%), IgA related vasculitis (8/29, 27%), poliarteritis nodosa (6/20, 30%), GPA (Wegener's) (2/32, 6%) and others (4/97, 4%). The diagnosis of GI vasculitis was based on their having: mesenteric vascular (14/30), GI tract (18/30) and/or solid GI organ involvement (2/30). 12/30 patients had presented with either GI bleeding or perforations. Among those who had GI tract lesions, gastro-duodenal involvement was present in 4/18 and intestinal in 16/18. 8 patients (35%) were dead 31 months (1-96) after their diagnosis. The causes of death were gastrointestinal involvement in 4/8 patients (3 bleeding, 1 perforation). The other 4 patients had died due to infections. Seven patients were lost to follow-up and 15 patients were doing well.
Conclusions GI involvement was present in 13% of our patients with systemic vasculitis on long term follow-up. Mortality and morbidity rates were considerably high. Mortality was either related to GI complications such as perforation and bleeding or infections associated with high dose immunosuppressives.
Disclosure of Interest None declared