Significance of Bowel Wall Abnormalities at Ultrasound in Henoch‐Schönlein Purpura

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 46; no. 1; pp. 48 - 53
• Main Authors: Nchimi, Alain, Khamis, Jamil, Paquot, Isabelle, Bury, Françoise, Magotteaux, Paul
• Format: Journal Article Web Resource
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01.01.2008; Lippincott; Lippincott Williams & Wilkins
• Subjects: Abdominal Pain; Biological and medical sciences; Bowel diseases; Child; Child, Preschool; Dermatology; Diseases of the osteoarticular system; Endoscopy, Gastrointestinal; Female; Gastrointestinal Diseases - diagnostic imaging; Gastrointestinal Diseases - etiology; Gastrointestinal Diseases/etiology/ultrasonography; Henoch Schönlein disease; Human health sciences; Humans; Immunoglobulin A hypersensitivity; Inflammatory joint diseases; Intestines - diagnostic imaging; Intestines - pathology; Intestines - physiopathology; Intestines/pathology/physiopathology/ultrasonography; Length of Stay; Male; Medical sciences; Purpura; Purpura, Schoenlein-Henoch - complications; Purpura, Schoenlein-Henoch - diagnostic imaging; Purpura, Schoenlein-Henoch - physiopathology; Purpura, Schoenlein-Henoch/complications/physiopathology/ultrasonography; Radiologie, médecine & imagerie nucléaire; Radiology, nuclear medicine & imaging; Rheumatoid; Sciences de la santé humaine; Sensitivity and Specificity; Ultrasonography; Vascular disorders of the skin; Sonography; Human; Performance evaluation; Immunopathology; Skin disease; Immunoglobulins; Hypersensitivity; Diseases of the osteoarticular system; Autoimmune disease; Cardiovascular disease; Inflammatory joint disease; Vascular disease; Immunoglobulin A hypersensitivity- Ultrasonography-Bowel diseases-Purpura-Rheumatoid- Henoch Schönlein disease; Symptomatology; Chronic; Rheumatoid arthritis; Echography; Henoch-Schönlein purpura; Capillary vessel disease; Diagnosis; Predictive factor; Child; Ultrasound
• ISSN: 0277-2116; 1536-4801; 1536-4801
• DOI: 10.1097/01.mpg.0000304453.99799.8c

ABSTRACT Objectives: To describe the polymorphism of intestinal ultrasound findings in children with gastrointestinal symptoms of Henoch Schönlein purpura (HSP) and to investigate the clinical relevance of these findings in terms of symptoms and length of hospitalization. Patients and Methods: Clinical and ultrasound data from 43 consecutive children with HSP (36 with and 7 without abdominal symptoms) were reviewed. Patients with abdominal symptoms of HSP were divided into 4 groups (0–III) representing at ultrasound normal appearance and differentiated, pseudodifferentiated, and dedifferentiated bowel wall thickening, respectively. The diagnostic value of ultrasound in diagnosing gastrointestinal involvement of HSP (grades I–III) was calculated using as the standard of reference the absence or presence of clinical symptoms. Average duration of symptoms and hospitalization in the 4 groups was compared. Results: The respective sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for the diagnosis of gastrointestinal involvement of HSP was 83.3%, 100%, 100%, and 53.8%. Groups 0 to III contained, respectively, 5/36 (13.9%), 6/36 (16.7%), 22/36 (61.1%), and 3/36 (8.3%) patients. The groups' average duration of symptoms, respectively, was 2.20 ± 2.06, 5.67 ± 1.88, 6.29 ± .94, and 17.67 ± 2.66 days, whereas the length of hospitalization, respectively, was 4.80 ± 2.96, 9.17 ± 2.70, 11.46 ± 1.35, and 24.67 ± 3.82 days. The duration of both symptoms and hospitalization was significantly higher in group III than in the other groups (P < 0.05). Conclusions: In children with gastrointestinal involvement of HSP, dedifferentiated wall thickening as shown by ultrasound is associated with a poor clinical prognosis.