GI involvement in Henoch-Sch[ouml ]nlein purpura

Esaki, Motohiro; Matsumoto, Takayuki; Nakamura, Shotaro; Kawasaki, Mikio; Iwai, Keiichiro; Hirakawa, Kenji; Tarumi, Ken-ichi; Yao, Takashi; Iida, Mitsuo

doi:10.1067/mge.2002.129592

Cited by 26 publications

(9 citation statements)

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“…It is reported that 31-66.7% patients have the complaints of gastrointestinal (GI) symptoms, manifesting as paroxysmal umbilical pain, hematemesis, and hematochezia [4,5]. Some patients can even progress to severe GI complications, such as intussusception, intestinal perforation and hemorrhagic enteritis [6]. Although HSP tends to be self-limiting, it still can develop some long-term complications.…”

Section: Introductionmentioning

confidence: 99%

Hemoperfusion and intravenous immunoglobulins for refractory gastrointestinal involvement in pediatric Henoch-Schönlein purpura: a single-center retrospective cohort study

Zhang

Che

et al. 2022

BMC Pediatr

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Background Henoch-Schönlein purpura (HSP) with refractory gastrointestinal (GI) symptoms is always difficult to handle because of its resistance to supportive therapies and glucocorticoid. This study aimed to evaluate the efficacy of hemoperfusion (HP) and intravenous immunoglobulins (IVIG) therapies in this population. Methods Sixty-four HSP patients with refractory GI involvement (R-GI group) and 64 cases with mild GI symptoms (control group) were retrospectively analyzed in our center from March 2016 to October 2019. In R-GI group, 42 cases (subgroup A) were treated with IVIG and steroid, 13 cases (subgroup B) used HP and steroid, 9 cases (subgroup C) executed a combination of IVIG, HP and steroid. Demographic characteristics, clinical features, laboratory indexes and treatment outcomes were recorded. t-test, One-way ANOVA, Mann-Whitney U test, and multivariate logistic regression were used in comparing differences among subgroups and predicting independent risk factors. Results Compared with the control group, R-GI cases experienced higher risk of renal involvement (P = 0.000), more steroid exposure (P = 0.000), six times expenses (P = 0.000) and 2.3 times length of hospitalization (P = 0.000). The independent risk factors of R-GI group were elevated neutrophils (OR 1.250 [95% CI 1.130-1.383]) and the percentage of B lymphocytes (OR 1.100 [95% CI 1.026-1.179]) as well as decreased IgG (OR 0.847 [95% CI 0.732-0.98]). In R-GI group, increased age (OR 1.039 [95% CI 1.016-1.062]) and IgM (OR 5.994 [95% CI 1.403-27.611]) were verified to be risk factors of HSP nephritis. All three subgroups could alleviate the symptoms effectively. Compared with those in subgroup A, patients in subgroup B were elder (P = 0.004), had less relapse (P = 0.002), steroid exposure (P = 0.033) and expenses (P = 0.031), more significant decrease of WBC (P = 0.026) after treatment. Conclusion The HSP with refractory GI involvement had much higher risk of medical burden and renal involvement. Both IVIG and HP therapies could ameliorate refractory GI symptoms efficiently. HP therapy tended to reduce the relapse, costs and steroid exposure in its audiences who were cooperated and with stable hemodynamics, while IVIG had better use in younger children.

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Section: Introductionmentioning

confidence: 99%

Hemoperfusion and intravenous immunoglobulins for refractory gastrointestinal involvement in pediatric Henoch-Schönlein purpura: a single-center retrospective cohort study

Zhang

Che

et al. 2022

BMC Pediatr

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Section: Discussionmentioning

confidence: 99%

“…Endoscopic findings associated with HSP include redness, swelling, petechiae, submucosal hemorrhage, purpura, erosions and ulceration (3,8). The small intestine, particularly the second portion of the duodenum, is the most frequently involved site (8). As the diagnostic yield of the endoscopic biopsy is low, the diagnosis of GI involvement of HSP depends on endoscopic findings and clinical features (9).…”

Section: Discussionmentioning

confidence: 99%

Rapid progression and recovery of massive gastric mucosal damage complicated by Henoch‑Sch�nlein purpura in a patient with liver cirrhosis: A case report

Gweon

Kwon

2019

Exp Ther Med

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Endoscopic findings associated with gastric ischemia include friable gastric mucosa, irregular ulceration, petechiae and purpura. The etiology of gastric ischemia includes shock, sepsis, thrombosis, embolism and vasculitis. Henoch-Schönlein purpura (HSP) is a leukocytoclastic vasculitis that affects small vessels in the skin, kidney and gastrointestinal (GI) tract. Rapid progression of HSP manifested with acute gastric mucosal bleeding has been rarely reported. The present case study reports on a patient who had undergone endoscopic variceal ligation for esophageal varix bleeding and the gastric mucosa exhibited no evidence of HSP. After 9 days, reexamination using endoscopy to check for new-onset hematemesis revealed massive necrosis in the gastric mucosa, friable mucosal tissue and acute ischemic GI bleeding. The patient was treated with corticosteroid injections for 7 days, which caused a marked regression of the hemorrhagic gastric mucosa. The present case study reported on this patient with acute GI bleeding caused by HSP who was successfully treated with corticosteroids.

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“…Churg-Strauss syndrome (40). One possible explanation for these reports is the unmasking of previously unsuspected cases of Churg-Strauss syndrome through the reduction of oral steroid therapy and its replacement with LTRA (40). Given the possibility that leukotriene antagonists may directly activate Churg-Strauss syndrome, LTRA treatment should be withdrawn in any patient who develops systemic symptoms with hypereosinophilia (40).…”

Section: Discussionmentioning

confidence: 99%

Effects and Zafirlukast on Capsular Contracture: Long-Term Results

Mazzocchi

Dessy

Alfano

et al. 2012

Int J Immunopathol Pharmacol

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Capsular contracture is a distressing complication after breast augmentation for both the patient and surgeon. Although capsular contracture is a multifactorial process, one common denominator in the successful treatment of this complication is believed to be the abatement of inflammation. Leukotriene antagonists have recently emerged as effective prophylactic agents in reactive airway diseases. A prospective study was carried out on 60 female patients (120 prostheses implanted) with mild/severe capsular contracture in at least one breast. The hardness of capsular contracture was assessed by means of the mammary compliance method. Patients received zafirlukast (AccolateTM) for a 6-month period. Mammary compliance was assessed at the start of the study and thereafter monthly, during drug intake and for one year after drug withdrawal. The results show a significant decrease in breast compliance values in the first 6 months, followed by a significant increase one year after the end of drug intake. Indeed, zafirlukast-treated patients displayed a 6.93% reduction in mammary compliance after 1 month, 14.42% after 3 months, 22.05% after 6 months and 22.52% after 7 months (1 month after the withdrawal of the drug). Thereafter, mammary compliance values gradually increased. A 5.47% reduction in mammary compliance was observed 1 year after drug withdrawal. The present study suggests that zafirlukast may be effective in reducing breast capsule distortion in patients with long-standing contracture, though reduced capsular contracture values are strictly related to the duration of drug intake. Capsular contracture is the most common problem and cause of patient dissatisfaction following augmentation mammaplasty and mammary reconstruction with breast implants; the reported rates of this complication range from 0.5 to 59% (1).Every patient who undergoes implantation with an alloplastic implant experiences capsules around the prostheses. Fibrotic tissue promotes compression around the implant, which in tum distorts and deforms the mass, compromising the aesthetic result and causing pain (2-7). Breast firmness that is so marked as to result in a painful, hard breast, on occasion with visible distortion, has been termed fibrous capsular contracture (8). A number of intraoperative and postoperative factors may be linked to capsular contracture. Unfortunately, as few strictly-controlled studies have been conducted to investigate the causes and possible prevention of capsular contracture, there are as yet no definite data on the aetiopathogenesis of this complication (8). Although the pathogenesis of capsular contractere is still unclear, most reports indicate a multifactor explanation (2-6).The development of a fibrotic capsule around

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GI involvement in Henoch-Sch[ouml ]nlein purpura

Cited by 26 publications

References 0 publications

Hemoperfusion and intravenous immunoglobulins for refractory gastrointestinal involvement in pediatric Henoch-Schönlein purpura: a single-center retrospective cohort study

Hemoperfusion and intravenous immunoglobulins for refractory gastrointestinal involvement in pediatric Henoch-Schönlein purpura: a single-center retrospective cohort study

Rapid progression and recovery of massive gastric mucosal damage complicated by Henoch‑Sch�nlein purpura in a patient with liver cirrhosis: A case report

Effects and Zafirlukast on Capsular Contracture: Long-Term Results

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