Gastrointestinal Involvement in Systemic Vasculitis

Writing in the journal Current Opinion in Rheumatology Turkish researchers review the current literature on gastrointestinal involvement in different types of vasculitis. They address the variability of gastrointestinal involvement and of clinical findings, as well as treatment. An inflammatory bowel disease diagnosis usually precedes a diagnosis of vasculitis. A systematic review of the literature points to large vessel (mostly Takayasu arteritis), cutaneous vasculitis and ANCA-Associated Vasculitis (AAV) (mostly granulomatosis with polyangiitis, or GPA) as the three most common types of vasculitis associated with IBD. Primary vasculitides most commonly associated with a higher frequency of gastrointestinal involvement include immunoglobulin A (IgA) and anti-neutrophilic cytoplasmic antibodies (ANCA)-associated vasculitis (AAV), polyarteritis nodosa (PAN) and Behcet’s syndrome. Takayasu arteritis is associated with gastrointestinal symptoms that resemble inflammatory bowel diseases (IBD) in some patients. And, rheumatoid arthritis and systemic lupus erythematosus (SLE) can be associated with secondary vasculitis and gastrointestinal involvement. Patients with vasculitis symptoms typically experience abdominal pain, fever, diarrhea, nausea, vomiting and sometimes bleeding. They can also experience aneurysms or occlusions in mesenteric, hepatic or splenic vessels. An accurate diagnosis is difficult and usually includes imaging which may reveal an inflamed gastrointestinal tract with erosions, or ulcers that can lead to perforation, bleeding and bowel obstruction. Currently angiography is the gold standard for diagnosis of mesenteric vascular lesions especially if endovascular therapeutic interventions are needed. Vasculitis of solid organs in the pancreas, liver and gallbladder can occur in patients as well. Treatment depends on the type of vasculitis and is usually with high-dose corticosteroids and immunosuppressives. This article sums up the review as follows: