Late‐onset gastrointestinal pain in juvenile dermatomyositis as a manifestation of ischemic ulceration from chronic endarteropathy

Mamyrova, Gulnara; Kleiner, David E.; James-Newton, Laura; Shaham, Bracha; Miller, Frederick W.; Rider, Lisa G.

doi:10.1002/art.22782

Cited by 61 publications

(58 citation statements)

References 11 publications

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“…In cases of juvenile DM, vascular abnormalities in gastroduodenal mucosa, as well as bioelectric activity of gastric muscles, have been described. [14][15][16][17] Although serious, the presence of vascular disease of the gastrointestinal tract in juvenile DM is rare. 18 Thus, the primary objective of this study was to evaluate the upper digestive endoscopy (UDE) of adult DM patients.…”

Section: ■ Resultsmentioning

confidence: 99%

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Morphological alterations of upper gastrointestinal tract in patients with new onset-dermatomyositis: correlation with demographic, clinical and laboratory features

Amorim¹,

Furuya²,

Marques³

et al. 2017

Medical Express

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OBJECTIVE:To endoscopically assess the upper digestive tract of adult patients with newly diagnosed dermatomyositis; to correlate possible changes in the gastrointestinal tract with demographic, clinical and laboratory features in this population. METHOD: A cross-sectional study evaluating 65 newly diagnosed dermatomyositis cases from 2004 to 2015 was carried out. We excluded patients with clinically amyopathic dermatomyositis, overlap dermatomyositis, polymyositis, liver diseases, prior gastric surgery, upper gastrointestinal tract symptoms (except for upper dysphagia), systemic infections, alcohol consumption and smoking. RESULTS: Mean age of patients was 44.9 years, with disease duration of four months. Endoscopic findings were observed in 70.8% of patients. (1) Esophageal disease/gastric distress was documented in 18.5% of patients: erosive distal esophagitis (16.9%) and non-erosive distal esophagitis distal (1.5%); (2) gastric distress in 63.1% of cases: antral gastritis (42.3%) and pangastritis (27.8%); (3) duodenal involvement in 15.4% of patients: bulbar duodenitis (10.9%) and duodenal ulcers (7.7%). There were no neoplasic lesions. On multivariate analysis, erosive distal esophagitis was less associated with older patients. Males had a higher prevalence of erosive gastritis. Enanthematous pangastritis was less associated with lesions with "V-neck" sign lesions. CONCLUSIONS: This study provides the first estimates of the prevalence of high endoscopic findings in adult patients with newly diagnosed dermatomyositis. The results may be relevant to guide conduct in digestive disorders with upper digestive endoscopy, and point to the need for pharmacological prevention of digestive tract lesions in these patients. Further studies are needed to validate this data and evaluate patients with dyspeptic symptoms.

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Section: ■ Resultsmentioning

confidence: 99%

“…Although well-documented in juvenile DM, [14][15][16][17][18] there are currently no descriptions of endoscopic findings of the upper digestive tract in adult patients with DM.…”

Section: ■ Conflict Of Interestmentioning

confidence: 99%

Morphological alterations of upper gastrointestinal tract in patients with new onset-dermatomyositis: correlation with demographic, clinical and laboratory features

Amorim¹,

Furuya²,

Marques³

et al. 2017

Medical Express

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“…This hypothesis is consistent with the observation that GI complications are usually a long-term complication of JDM, often when the muscle disease is in good control. The biopsies in these paediatric cases8 12 often reveals a non-inflammatory vasculopathy, which is likely the down-stream damage caused by earlier inflammation. This model of early vasculitis leading to damage and late ischaemic non-inflammatory vasculopathy is seen is lupus (SLE).…”

Section: Discussionmentioning

confidence: 99%

Colonic vasculopathy and perforation in the initial presentation of adult dermatomyositis in a patient with improving muscle weakness

2016

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A 63-year-old woman with diabetes presented with 8 weeks of proximal muscle weakness and change in bowel habits. Muscle biopsy confirmed myositis, and serological studies were consistent with dermatomyositis (DM), without evidence of overlapping connective tissue disease or malignancy. On day 12 of prednisone therapy and after receiving one dose of IVIG with improvement in muscle strength, the patient developed abdominal pain and was diagnosed with a gastrointestinal (GI) perforation and peritonitis requiring emergent colectomy. The pathology revealed diffuse mucosal ulceration, prominent lymphoplasmacytic infiltration, venous occlusion and arterial hyperplasia. Although GI manifestations due to GI vasculopathy are rare in adult DM and are often a delayed complication, in this patient, it was one of the initial manifestations of this condition. In addition to being a fatal complication, clinicians should be aware of these complications, as immunosuppression used to control the muscular and cutaneous inflammation may not control the GI vasculopathy.

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“…Chronic endarteropathy has been reported in JDM patients [2,3]. Here, we present the case of an adult DM patient with this vascular manifestation.…”

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confidence: 80%

Gastrointestinal endarteropathy in adult dermatomyositis

2016

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Late‐onset gastrointestinal pain in juvenile dermatomyositis as a manifestation of ischemic ulceration from chronic endarteropathy

Cited by 61 publications

References 11 publications

Morphological alterations of upper gastrointestinal tract in patients with new onset-dermatomyositis: correlation with demographic, clinical and laboratory features

Morphological alterations of upper gastrointestinal tract in patients with new onset-dermatomyositis: correlation with demographic, clinical and laboratory features

Colonic vasculopathy and perforation in the initial presentation of adult dermatomyositis in a patient with improving muscle weakness

Gastrointestinal endarteropathy in adult dermatomyositis

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