RADIOGRAPHIC AND ENDOSCOPIC EVALUATION OF GASTROINTESTINAL TRACTUS IN CHILDREN WITH HENOCH - SCHONLEIN SYNDROME

Gastrointestinal (GI) tractus involvement of HenochSchönlein syndrome (HSS) is well known. The aim of this study was to assess the radiographic and endoscopic findings ofGI tract in children with HSS. This study included a total of 40 patients (25 girls, 15 boys), aged 3 to 14 years (average 8.52±3.08 years). Fifteen age-and sex-matched healthy subjects served as controls for sonographic parameters. Patients were initially evaluated with abdominal computerized tomography (CT) (40 pts), doppler ultrasonography (US) (29 pts) and upper GI endoscopy(I6 pts). Duodenum wall thickness (DWT), duodenal diameter (DD) and stomach wall thickness (SWT) were measured with US. Doppler US was repeated in 20 of 29 patients after 6 months of clinical improvement. Immunohistology of biopsy specimens obtained during endoscopy was also assessed. Statistical evaluation was made by Mann-Whitney-U and Wilcoxon tests. Abdominal ÇT findings consistent with intestinal gas distension and hypomotility (8 cases), intestinal wall thickness (6 cases) and free abdominal fluid (4 cases). Mean DWT (2.69±0.85 mm vs. 1.91±0.18 mm), DD (5.81±l.45 mm vs. 4.54±0.43 mm) and SWT (3.32±0.71 mm vs 2.08±0.18 mm) values detected by US were significantly higher in patients compared with controls (p<0.01). After 6 months these values regressed to normal controls. Endoscopy revealed erythematous gastritis in 12 of 16 cases (75%), mucosal redness in 6 (37%) and purpuric lesion in 3 (18%). Biopsy demonstrated no immune deposits in 16 pts. In 4 cases in whom histologic evaluation was also performed, nonspesific inflamatory findings were determined on biopsy specimens. Sensitivity, spesificity, negative predictive value and positive predictive values for DWT and DD detected with US were 71%, 50%, 66% and 71%, whereas 90%, 100%, 100% and 90% for SWT and 35%, 50%, 90% and 35% for abdominal ÇT, respectively. In conclusion, US may be the preferable option in children with HSS to detect GI involvement, especially when GI symptoms develop prior to the cutaneous lesions.