GASTROINTESTINAL-TRACT INVOLVEMENT IN POL YARTERITIS-NODOSA AND CHURG-STRAUSS-SYNDROME

Citation
L. Guillevin et al., GASTROINTESTINAL-TRACT INVOLVEMENT IN POL YARTERITIS-NODOSA AND CHURG-STRAUSS-SYNDROME, Annales de medecine interne, 146(4), 1995, pp. 260-267
Citations number
39
Categorie Soggetti
Medicine, General & Internal
Journal title
ISSN journal
0003410X
Volume
146
Issue
4
Year of publication
1995
Pages
260 - 267
Database
ISI
SICI code
0003-410X(1995)146:4<260:GIIPYA>2.0.ZU;2-E
Abstract
Objective. - To study the nature and incidence of gastrointestinal (GI ) manifestations in polyarteritis nodosa (PAN) and Churg-Strauss syndr ome (CSS) and define their therapeutic and prognostic implications. Me thods. - Fifty-three patients (29 males, 24 females) affected with PAN or CSS and followed in our institution were included in a retrospecti ve study. Patients were divided into 2 groups : patients without GI ma nifestations (group A) and patients with GI manifestations (group B), Among patients with GI manifestations we have studied a subgroup with a possibly poorer prognosis in whom the following symptoms were presen t: GI tract hemorrhage, intestinal perforation, digestive tract surger y due to PAN manifestations, intractable abdominal pain and weight los s greater than 20% of normal weight due to GI tract ischemia, Results. - The clinical manifestations were those that are classically encount ered in PAN and CSS. Every patient fulfilled the American College of R heumatology (ACR) criteria for PAN and CSS. Thirty-five patients witho ut GI manifestations were included in group A and 18 patients (34%) wi th GI manifestations in group B. The mean age of the group at the time of diagnosis was 56.9 +/- 19.1 years (range : 21-71 years) in group A and 47.5 +/- 16.8 years (range : 12-82) in group B. GI manifestations were considered as one of the symptoms revealing PAN in 7 (13.2%) cas es. Six of the 18 patients with GI manifestations had definite organ i nvolvement related to vasculitis. Abdominal pain without characteristi c organ involvement or surgical emergency was present in 12/18 patient s, HBV infection was more frequently observed in group B than in group A, Survival curves showed that at 10 years, 80% of the patients in gr oup A were alive versus 67% in group B (P not significant). For the 9 patients with severe GI manifestations, the survival curves showed tha t, at 10 years, 44% of them were alive versus 80% in the other group A (p < 0.001). Conclusions. - GI manifestations are frequent in PAN and CSS and were present in 34% of our patients. Prognosis of PAN with Gf manifestations is not statistically different than in PAN without GI involvement, except for patients with severe digestive complications.