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
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.