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[Intestinal vasculitis--a diagnostic-therapeutic challenge].
1Medizinische Klinik und Poliklinik B, Westfälische Wilhelms-Universität Münster.
Zeitschrift Fur Gastroenterologie
|March 18, 2000
Summary
Intestinal vasculitis, a rare cause of mesenteric ischemia, presents with nonspecific abdominal symptoms. Careful observation of extraintestinal signs and biopsy are crucial for diagnosis and treatment with glucocorticoids and immunosuppressants.
Area of Science:
- Gastroenterology
- Rheumatology
- Vascular Medicine
Context:
- Intestinal vasculitis is an uncommon cause of mesenteric ischemia.
- It often leads to chronic arterial insufficiency, but can also cause acute mesenteric ischemia.
- Nonspecific abdominal symptoms like postprandial intestinal angina, diarrhea, anorexia, and perforation hinder diagnosis.
Purpose:
- To highlight the diagnostic challenges of intestinal vasculitis.
- To emphasize the importance of recognizing extraintestinal manifestations for diagnosing systemic vasculitis involving intestinal arteries.
- To outline diagnostic and therapeutic strategies for intestinal vasculitis.
Summary:
- Conventional imaging and endoscopy are insufficient for diagnosing intestinal vasculitis.
- Diagnosis relies on identifying extraintestinal symptoms, specific laboratory markers (e.g., ANCA, anti-ds-DNA antibodies), tissue biopsy, and histological analysis.
- Angiography aids in diagnosing vasculitis affecting medium to large vessels.
Impact:
- Early and accurate diagnosis of intestinal vasculitis is essential for timely intervention.
- Treatment typically involves glucocorticoids, with cyclophosphamide added for severe visceral or renal involvement.
- Alternative immunosuppressive agents are considered for refractory cases, and empirical glucocorticoid therapy may be initiated in diagnostically challenging situations.