GI involvement in Henoch-Schonlein purpura

Background: The diagnosis of Henoch-Schonlein purpura is difficult, especially when abdominal symptoms precede cutaneous lesions. The aim of this study was to determine the distribution of GI involvement in Henoch-Schonlein purpura. Methods: Endoscopic or radiographic findings throughout the entire GI tract were retrospectively reviewed for 7 patients with Henoch-Schonlein purpura. Histopathologic findings were analyzed and correlated with findings at EGD and colonoscopy. Observations: The duodenum and small intestine were most frequently involved (6 patients, each site). Contrast radiography of the small intestine demonstrated thickened mucosal folds or small barium flecks. Findings at EGD were multiple irregular ulcers, mucosal redness and petechiae in the duodenum. In 4 patients, the second part of the duodenum was predominantly affected. Ulcerating lesions accompanied by hematoma-like protrusions were detected in 4 patients in whom leukocytoclastic vasculitis was proven histopathologically. Conclusions: EGD appears to have the greatest diagnostic utility in patients suspected to have Henoch-Schonlein purpura with GI involvement.