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[Clinical manifestations and endoscopic features of abdominal type Henoch purpura in children]
Zhong-yue Li1, Xiao-lei Huang, Jie Chen
1Department of Gastroenterology, Children's Hospital, Medical College, Zhejiang University, Hangzhou 310003, China.
Insights
Henoch purpura in children commonly affects the descending duodenum, presenting with gastrointestinal symptoms. Upper gastrointestinal endoscopy aids in early diagnosis of this condition.
Area of Science:
- Pediatric Gastroenterology
- Rheumatology
- Pathology
Background:
- Henoch-Schönlein purpura (HSP) is a common vasculitis in children.
- Abdominal manifestations of HSP can precede or occur without characteristic skin purpura.
- Accurate diagnosis of abdominal Henoch purpura is crucial for timely management.
Purpose of the Study:
- To characterize the clinical and endoscopic findings of abdominal Henoch purpura in children.
- To evaluate the diagnostic utility of upper gastrointestinal endoscopy in these cases.
- To improve the diagnostic accuracy for abdominal Henoch purpura.
Main Methods:
- Retrospective analysis of 57 children hospitalized with abdominal Henoch purpura.
- Review of clinical, endoscopic, and histopathological data.
- Upper gastrointestinal endoscopy with mucosal biopsies for histopathology and Helicobacter pylori testing.
Main Results:
- Gastrointestinal symptoms included abdominal pain (79%), vomiting (56%), and hematochezia (19%).
- Endoscopic findings revealed mucosal congestion, edema, petechiae, ecchymosis, erosions, and ulcers, predominantly in the descending duodenum (96.5%).
- Histopathology showed vascular inflammation and bleeding; 5.3% tested positive for H. pylori.
Conclusions:
- The descending duodenum is the most frequently and severely affected site in the upper GI tract in abdominal Henoch purpura.
- Upper gastrointestinal endoscopy combined with mucosal biopsy is a valuable tool for the early diagnosis of Henoch purpura.
- Cutaneous purpura developed in 86% of cases after endoscopy, with some cases showing delayed or absent skin manifestations.
Objective:
To investigate the clinical manifestations and endoscopic features of abdominal type Henoch purpura in children and improve the diagnostic level.
Methods:
Retrospective review was made on the clinical, endoscopic and histopathological features of 57 cases of children with Henoch purpura abdominal type who had been hospitalized from Jan. 2002 to May 2007. Upper gastrointestinal endoscopy was performed in all cases. All the cases had various digestive system symptoms without cutaneous purpura before endoscopy. Mucosal specimens were taken from sinus ventriculi and duodenum for histopathological analysis. Helicobacter pylori (H.pylori) infection was identified by rapid urease test and histology, and diagnosis of H.pylori infection was made when both were positive.
Results:
The common gastrointestinal symptoms of Henoch purpura were abdominal pain (46 cases), vomiting (32 cases), hematochezia (11 cases), diarrhea (4 cases) and abdominal distention (1 case). Three cases had arthralgia and joint swelling. The main laboratory findings were increased peripheral white blood cells (33 cases, 57.9%), 1/5 of cases had elevated C reactive protein (CRP), low serum albumin and seroperitoneum. Endoscopy demonstrated the damages to the mucosa, which varied from congestion, edema, petechia and ecchymosis (37 cases, 64.9%) to erosive and multiple ulcers (14 cases, 24.6%), granulation of mucosa in descendent duodenum (4 cases, 7.0%), and diffuse hemorrhage of mucosa (2 cases, 3.5%). The upper gastrointestinal endoscopy showed that the commonest and most serious position involved was the descendent duodenum (55 cases, 96.5%), followed by duodenal bulb (32 cases, 56.1%) and stomach (18 cases, 36.1%), esophagus was less involved (1 case, 1.8%). Histological manifestations showed swollen vascular endothelial cells of capillary vessels and small blood vessels, fibrotic necrosis of small vessels and bleeding, diffuse perivascular lymphocytic and neutrophilic infiltration and nuclear debris in mucosa and submucosa. Three cases (5.3%) were found infected with H. pylori. In 49 cases (86.0%) cutaneous purpura appeared 1 - 7 days after endoscopy. Eight cases had no cutaneous purpura until they left hospital. Two cases were lost to follow up and 6 cases (10.5%) remained free from cutaneous purpura were followed up until now (1 - 5 years).
Conclusion:
Descending duodenum is the commonest and most serious position of upper gastrointestinal tract involved in Henoch purpura. Upper gastrointestinal endoscopy with the mucosal biopsy are useful for the early diagnosis of Henoch purpura.
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