Modern diagnostic methods for early assessment of the abdominal involvement in Schönlein-Henoch disease

Abstract

Introduction: Schönlein-Henoch disease is a small vessel vasculitis resulting from IgA-mediated inflammation. It is the most common acute systemic vasculitis in childhood, mainly affecting the skin, gastrointestinal tract, joints, and kidneys. Although the prognosis of Schönlein-Henoch is generally good, gastrointestinal tract involvement is a potential complication, presenting as massive gastrointestinal bleeding, bowel infarction, perforation, as well as intussusception and peritonitis. Aim: In everyday clinical practice, determining markers of gastrointestinal tract involvement is critical when the initial or only available symptoms are related to it. Ultrasound diagnosis is effective as a first-line screening method in children with Schönlein-Henoch purpura and abdominal involvement, in order to objectivize changes in the small intestinal wall, such as thickening, disturbance of its stratification, and intramural bleeding. Materials and methods: Since, until recently, the generally accepted concept that there are neither coagulation disorders nor changes in the small intestinal wall’s ultrasound examination has limited our understanding of the essence of Schönlein-Henoch disease, we looked for more trustworthy indicators. Results: These indicators, such as factor XIII and von Willebrand factor-associated antigen, showed significant deviations from the reference ranges in our study of patients with abdominal pain who had Schönlein-Henoch disease. Conclusions: In conclusion, early assessment of altered coagulation factors f. XIII and vWF:Ag and ultrasound monitoring of changes in the small bowel wall proved to be a valid criterion for therapeutic accuracy as well as avoiding surgical complications.