Extraintestinal Manifestations of Hepatogastrointestinal Diseases

Hospital Physician July 2006 61 Hepatogastrointestinal diseases typically present with abdominal pain, nausea, diarrhea, and jaundice. However, certain hepatogastrointestinal diseases can present with extraintestinal signs and symptoms that can be misleading, such as skin rash and joint pains. Joint pains can be the initial manifestation reported by the patient with a hepatogastrointestinal disease and may precede disease onset by 1 year. Similarly, dermatologic conditions can be important clues to the diagnosis of some hepatogastrointestinal diseases, such as dermatitis herpetiformis in celiac sprue or pyoderma gangrenosum in Crohn’s disease. Conversely, some nongastrointestinal disease processes, such as the vasculitides, may present with abdominal pain, leading the examiner to focus on a gastrointestinal process. Diseases that have hepatogastrointestinal, musculoskeletal, and dermatologic manifestations include inflammatory bowel disease (IBD), celiac sprue, Whipple’s disease, dysentery, viral hepatitis, and certain vasculitides (Table 1). Polyarteritis nodosa and Henoch-Schönlein purpura are 2 vasculitides that can have gastrointestinal involvement of the mesenteric vasculature with abdominal pain as a manifestation.1 In addition, polyarteritis nodosa is a known complication of hepatitis B infection, and mixed cryoglobulinemia is a complication of hepatitis C infection. A thorough history and physical examination are needed to differentiate among the possible diagnoses in a patient presenting with diffuse joint pains, skin rashes, and gastrointestinal symptoms. This article discusses hepatogastrointestinal diseases that have associated joint pains and dermatologic manifestations.