[Abdominal manifestations of Henoch-Schönlein purpura in adults. A retrospective study of 23 cases].
BACKGROUND
Gastrointestinal manifestations of Henoch-Schönlein purpura (HSP) in adults may be severe. Data about treatment are controversial and the outcome is seldom described.


METHODS
Twenty-three patients with gastrointestinal manifestations of HSP (ACR criteria) were retrospectively studied. We proposed to use clinical and radiological (CT scan) severity scores to assess the usefulness and the efficacy of corticosteroid therapy.


RESULTS
Age at onset ranged from 16 to 80 years (median 39). Gastrointestinal manifestations included abdominal pain (96%), vomiting (52%), gastrointestinal bleeding (39%), diarrhoea (13%) and intestinal obstruction (9%). Scores of disease clinical severity were calculated in 21 patients. Fourteen, three and four had severe, intermediate and mild disease, respectively. Ten patients in the group with severe clinical involvement underwent CT scan that showed severe radiological involvement (parietal thickening of several bowel loops of the same segment or several segments with ileal involvement). Eleven patients out of 14 with clinically severe disease were given corticosteroids. Two patients out of three with intermediate and three patients out of four with mild scores also received corticosteroids. The others received supportive care. In-patients with severe clinical scores, gastrointestinal symptoms improved within 2 days when they were given corticosteroids and within 12.3 days without corticosteroids (p<0.0002). No side effect was observed with steroid therapy.


CONCLUSIONS
These results suggest that corticosteroids may reduce abdominal symptoms of HSP in adults with clinically severe disease. They are safe when CT scan is performed.
Service de médecine interne, CHU Gabriel-Montpied, 58, rue Montalembert, BP 69, 63001 Clermont-Ferrand cedex, France. trouillier.s@club-internet.fr
S
S
Trouillier
M
M
André
I
I
Delèvaux
H
H
Mahamedi
C
C
Affo
R
R
Kintossou
M
M
Ruivard
P
P
Souteyrand
P
P
Philippe
O
O
Aumaître
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology*; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
D000305:Adrenal Cortex Hormones