Gastrointestinal manifestations of systemic vasculitis: a spectrum of clinical manifestations, diagnosis and treatment

Abstract

Systemic vasculitides are a heterogeneous group of di­seases that are characterized by inflammation of blood vessel walls and are classified depending on the type and size of the vessels primarily involved in the pathological process. The gastrointestinal system may be involved in the pathological process in primary and secondary vasculitis. Gastrointestinal lesion is most common with IgA vasculitis, ANCA-associated vasculitis, polyarteritis nodosa and Behcet’s syndrome. Vascular involvement results from aneurysms or occlusions in the mesenteric, hepatic, or splenic vessels with the development of inflammation, erosion, or ulcers, which can lead to perforation, bleeding, and bowel obstruction and can be an important cause of morbidity and mortality in patients with vasculitis. Clinical signs are usually non-specific, including fever, abdominal pain, nausea, vomiting, diarrhea, and bleeding. Diagnosis is mainly based on imaging using catheter angiography, computed tomography and/or magnetic resonance angiography, endoscopy with histopathological examination. Treatment for gastrointestinal lesions depends on the type of vasculitis and usually involves the use of high doses of corticosteroids, immunosuppressants such as cyclophosphamide, azathioprine or mycophenolate mofetil, and biologicals. This literature review presents the latest data on the pathophysiology, clinical data, diagnosis, treatment, and outcome of gastrointestinal lesions in various types of systemic vasculitis.

Keywords

• systemic vasculitis
• gastrointestinal tract
• diagnosis
• treatment
• antineutrophil cytoplasmic antibodies
• behcet’s di­sease
• polyarteritis nodosa