Presentation and outcome of gastrointestinal involvement in hepatitis C virus-related systemic vasculitis: a case-control study from a single-centre cohort of 163 patients.
BACKGROUND
During primary systemic vasculitides gastrointestinal (GI) involvement is associated with a poor outcome, leading to the use of immunosuppressive therapy. The significance of GI involvement during hepatitis C virus (HCV)-related systemic vasculitis has never been evaluated.


OBJECTIVE
To evaluate the significance of GI involvement during HCV-related systemic vasculitis in the antiviral therapy era.


METHODS
Data from 163 patients were retrospectively reviewed to describe the presentation and outcome of patients with HCV-related systemic vasculitis with GI involvement (GI+), and to compare them with patients without GI involvement (GI-).


RESULTS
GI manifestations were present in 12 (7.4%) patients. Abdominal pain was consistently present in GI+ patients, and half of patients presented with surgical abdomen and/or intestinal bleeding. GI+ compared to GI- patients had more frequent renal (75% vs 30%; p=0.003) and cardiac involvement (25% vs 2%; p=0.006), medium-vessel vasculitis (67% vs 22%; p=0.003) and higher mixed cryoglobulinaemia levels (2.2 g/l vs 1.2 g/l; p=0.07). After treatment, GI+ and GI- patients had similar rates of overall clinical response of the vasculitis and immunological and virological responses. HCV-MC vasculitis patients with GI involvement did not have poorer overall survival than those without.


CONCLUSIONS
GI involvement is a rare manifestation of HCV-related vasculitis, associated with acute-onset and life-threatening manifestations. In contrast with primary vasculitides, GI+ patients do not seem to have poorer overall survival than GI- patients.
Terrier
Benjamin
B
Department of Internal Medicine, Groupe Hospitalier Pitié-Salpétrière, Université Pierre et Marie Curie, 75013 Paris, France.
Saadoun
David
D
Sène
Damien
D
Scerra
Sami
S
Musset
Lucile
L
Cacoub
Patrice
P
D015746:Abdominal Pain / Q000821:virology; D000208:Acute Disease; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D004812:Epidemiologic Methods; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging / Q000821:virology*; D006471:Gastrointestinal Hemorrhage / Q000821:virology; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D056647:Systemic Vasculitis / Q000000981:diagnostic imaging / Q000821:virology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000998:Antiviral Agents