Clinical and prognostic implications of gastrointestinal tract lesions in systemic vascular purpuras


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Abstract

Aim. To evaluate clinical peculiarities and prognostic value of abdominal syndrome in adult patients with systemic vascular purpura (SVP).
Material and methods. Incidence, clinical picture, complications of abdominal syndrome, its relations with principal extraintestinal manifestations of SVP were studied in 125 SVP patients. Absorption and barrier functions of the small intestine, their correlations with clinical activity of the disease were investigated in 32 SVP patients with no clinical signs of intestinal affection. Computer-assisted morphometry of duodenal mucosa biopsies was conducted and the results were compared to those of intestinal permiability and clinical activity of SVP.
Results. Negative correlation was found between the occurrence of abdominal syndrome and the patients' age. The gastrointestinal tract suffered more frequently in men. 21% patients had abdominal complications, association of abdominal syndrome with higher frequency of glomerulonephritis. In the absence of abdominal symptoms, the barrier function of the small intestine for protein macromolecules was impaired. This correlated with exacerbations of skin purpura. Increased intestinal permeability and activity of skin purpura correlated with severity of inflammation in the duodenal mucosa. Conclusion. Abdominal syndrome in SVP is an unfavourable prognostic factor indicating possible severe complications and high risk of glomerulonephritis. Subclinical intestinal involvement presenting as barrier dysfunction may contribute to aggravation of skin vasculitis.

About the authors

N A Mukhin

ММА им. И. М. Сеченова

ММА им. И. М. Сеченова

S V Gulyaev

ММА им. И. М. Сеченова

ММА им. И. М. Сеченова

О G Krivosheev

ММА им. И. М. Сеченова

ММА им. И. М. Сеченова

Е N Semenkova

ММА им. И. М. Сеченова

ММА им. И. М. Сеченова

E A Kogan

ГУ НИИ питания РАМН

Лаборатория физиологии и биохимии пищеварения; ГУ НИИ питания РАМН

N L Okhotnikova

ММА им. И. М. Сеченова

ММА им. И. М. Сеченова

V Ya Zavodnov

ММА им. И. М. Сеченова

ММА им. И. М. Сеченова

I V Gmoshinsky

ГУ НИИ питания РАМН

Лаборатория физиологии и биохимии пищеварения; ГУ НИИ питания РАМН

V K Mazo

ГУ НИИ питания РАМН

Лаборатория физиологии и биохимии пищеварения; ГУ НИИ питания РАМН

R Grane

Королевский медицинский колледж

Лондон; Королевский медицинский колледж

I Bjarnason

Королевский медицинский колледж

Лондон; Королевский медицинский колледж

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