ÇOCUKLARDA HENOCH SCHÖNLEİN PURPURASI, GASTROİNTESTİNAL SİSTEM TUTULUMU VE TEDAVİSİ

Year 2008, Volume: 9 Issue: 2, 17 - 20, 01.08.2008

Yılmaz Tabel Melek Çetin

Abstract

Amaç:Henoch-Schönlein purpurası çocukluk çağının IgAaracılığı ile oluşan otoimmün vaskülitidir. Genelliklepurpurik döküntü, karın ağrısı, artrit veya hematüri ile ortaya çıkmaktadır. Gastrointestinal tutulumlu çocuklardakarın ağrısı sık bir yakınmadır. Bu çalışmada; Henoch-Schönlein purpuralı çocuklarda gastrointestinal sistemtutulumunu ve onun steroidle tedavisini araştırdık.Gereç ve Yöntem:Aralık 2005 ileAralık 2007 arasındaki iki yıllık sürede Henoch-Schönlein purpurası tanısıylaizlenen hastalar çalışma grubunu oluşturdu. Gastrointestinal tutulumu olan hastalara düşük doz steroid kullanıldı.Bulgular:Toplam 31 hastanın üçünde (%9,6) hafif, beşinde (%16,1) ağır karın ağrısı, beşinde (%16,1) isegaitada belirgin ve/veya gizli kanama saptandı.Sonuç: Henoch-Schönlein purpuralı çocuklarda gastrointestinal tutulumu yaklaşık %60 sıklıkta ve bu sisteminağır tutulumunun tedavisinde steroidi etkili bulduk

Keywords

Henoch Schönlein purpurası, çocukluk çağı, gastrointestinal tutulum, steroidler

Gastrointestinal System Involvement and Its Treatment in ChildrenWith Henoch-Schonlein Purpura

Abstract

Purpose: Henoch Schönlein purpura is an IgA-mediated autoimmune vasculitis of children. It often presents with symptoms including purpuric rash, abdominal pain, renal involvement or arthritis. Abdominal pain is a frequent symptom in children with gastrointestinal involvement. We sought to evaluate gastrointestinal involvement in children with Henoch Schönlein purpura and the efficiency of steroid treatment of this condition. Materials and Methods: Aretrospective study of 31 patients diagnosed with Henoch-Schönlein purpura between December 2005 and December 2007 was conducted. Low dose steroid was used in children with gastrointestinal involvement. Results: Of the 31 patients, 3 (9.6%) had mild abdominal pain, 5(16.1%) colicy abdominal pain and 5 (16.%) suffered either overt gastrointestinal bleeding or had positive stool occult blood. Conclusion: We found gastrointestinal involvement in about 60% of children with Henoch-Schönlein purpura and steroid treatment in cases with severe involvement was effective.

Keywords

Henoch Schönlein purpura, childhood, gastrointestinal involvement, steroids

References

• 1. Coppo R, Amore A. Henoch-Schonlein purpura. In: Avner AD, Harmon WE, Niaudet P, editors. Pediatric Nephrology, 5th ed. Philadelphia: Lippincott Williams&Wilkins 2004: 851-63.
• 2. Cassidy JT, Petty RE. Henoch-Schönlein purpura. Textbook of Pediatric Rheumatology. Tokyo: W.B. Saunders Company, 1995: 384-88.
• 3. Mir S, Yavascan O, Mutlubas F, Yeniay B, Sonmez F. Clinical outcome in children with Henoch-Schönlein nephritis. Pediatr Nephrol 2007; 22: 6470.
• 4. Chang WL, Yang YH, Lin YT, Chiang BL. Gastrointestinal manifestations in Henoch-Schönlein purpura: a review of 261 patients. Acta Paediatr 2004; 93: 1427-31.
• 5. Cakir M, Orhan F, Mungan I, et al. Henoch-Schönlein purpura in north-eastern Turkey. Ann Trop Paediatr 2006; 26(1): 59-65.
• 6. Aksu N, Akın M, Yavaşcan Ö, Erdoğan H, ve ark. Henoch-Schönlein sendromlu çocuklarda gastrointestinal sistemin endoskopi ve radyolojik yöntemlerle değerlendirilmesi. Nefroloji Dergisi 2001; 10(2); 98102.
• 7. Lin SJ, Chao HC, Huang JL. Gastrointestinal involvement as the initial manifestation in children with Henoch-Schönlein purpura; clinical analysis of 27 cases. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1998; 39(3):18690.
• 8. Shin JI, Lee JS, Chung KS. Dapsone therapy for Henoch-Schonlein purpura. Arch Dis Child 2006; 91(8): 714.
• 9. Shimomura N, Kawai K, Watanabe S, Katsuumi K, Ito M. Adult Henoch-Schönlein purpura with severe abdominal pain treated with dapsone and factor XIII concentrate. J Dermatol 2005; 32(2):124-7.
• 10. Mills JA, Michel BA, Bloch DA, Calabrese LH, Hunder GG, Arend WP, et al. The American College of Rheumatology 1990 criteria for the classification of Henoch-Schönlein purpura. Arthritis Rheum 1990; 33: 1114-21.
• 11. Akalın F, Çalışkan S, Sever L, ve ark. HenochSchönlein purpuralı çocuklarda klinik bulgular ve akut faz reaktanları ilişkisi. İstanbul Çocuk Kliniği Dergisi 1993; 28: 106-11.
• 12. Gülcan EM. Henoch-Schönlein purpuralı çocuklarda gastrointestinal sistem tutulumunun klinik ve laboratuar bulguları. Bakırköy Tıp Dergisi 2007; 3(3): 94-100.
• 13. Gardner-Medwin JMM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch-Schonlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 2002; 360: 1197-1202.
• 14. Ebert EC. Gastrointestinal manifestations of HenochSchonlein purpura. Dig Dis Sci 2008; 53(8): 2011-9.
• 15. Schwab J, Benya E, Lin R, Majd K. Contrast enema in children with Henoch-Schonlein purpura. J Pediatr Surg 2005; 40:1221-3.
• 16. Trapani S, Micheli A, Grisolia F, Resti M, Chiappini E, Falcini F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. SeminArthr Rheum 2005; 35(3):143-53.
• 17. Saulsbury FT. Henoch-Schonlein purpura in children. Report of 100 patients and review of the literature. Medicine 1999; 78(6): 395-409.
• 18. Lindenauer SM, Tank ES. Surgical aspects of HenochSchonlein's purpura. Surgery 1960; 59(6): 982-7.
• 19. Cull DL, Rosario V, Lally KP, Ratner I, Mahour GH. Surgical implications of Henoch-Schonlein purpura. J Pediatr Surg 1990; 25(7): 741-3.
• 20. Wu CS, Tung SY. Henoch-Schonlein purpura complicated by upper gastrointestinal bleeding with an unusual endoscopic picture. J Clin Gastroenterol 1994; 19(2): 128-31.
• 21. Yavuz H, Arslan A. Henoch-Schonlein purpura-related intestinal perforation: a steroid complication? Pediatr Int 2001; 43(4): 423-5.
• 22. Connolly B, O'Halpin D. Sonographic evaluation of the abdomen in Henoch-Schonlein purpura. ClinRadiol 1994; 49(5): 320-3.
• 23. Ozdemir H, Iik S, Buyan N, Hasanolu E. Sonographic demonstration of intestinal involvement in HenochSchonlein syndrome. Eur J Radiol 1995; 20(1): 32-4.
• 24. Narin N, Akcoral A, Aslin MI, Elmastas H. Ranitidine administration in Henoch-Schonlein vasculitis. Acta Pediatr Jap 1995; 37(1):37-9.
• 25. Fagbemi Andrew AO, Torrento F, Hilson Andrew JW, Thomson MA, Heuschkel RB, Murch, SH. Massive gastrointestinal haemorrhage in isolated intestinal Henoch-Schonlein purpura with response to intravenous immunoglobulin infusion. Eur J Pediatr 2007; 166:915-9.
• 26. Gonzalez-Gay MA, Llorca J. Controversies on the use of corticosteroid therapy in children with HenochSchonlein purpura. Semin Arthr Rheum 2005; 35(3):135-7.
• 27. Ronkainen J, Koskimies O, Ala-Houhala M, Antikainen M, Merenmies J, Rajantie J, Ormala T, Turtinen J, Nuutinen M. Early prednisone therapy in Henoch-Schonlein purpura: a randomized, doubleblind, placebo-controlled trial. J Pediatr 2006; 149(2): 241-7.
• 28. Huber AM, King J, McLaine P, Klassen T, Pothos M. A randomized, placebo-controlled trial of prednisone in early Henoch Schonlein Purpura BMC. Medicine 2004; 2: 7.