Clinical Characteristics of Childhood Henoch-Schönlein Purpura with Duodenal Involvement by Upper Gastrointestinal Endoscopy

Abstract

Purpose: The aim of this study was to investigate the clinical usefulness of upper gastrointestinal (GI) endoscopy in children with Henoch-Schönlein purpura (HSP). Methods: We retrospectively analyzed the clinical, endoscopic, and histopathologic records of children with HSP who had been admitted to the Department of Pediatrics of Gil Hospital and underwent upper GI endoscopy between January 2002 and June 2009. Patients were classified into the following two groups for statistical analysis: duodenal involvement (+) and duodenal involvement (−). Results: Fifty-one children with HSP underwent upper GI endoscopy; the mean age was 7.2±2.9 years. The upper GI endoscopy showed abnormalities of the duodenum in 38 cases (74.5%), 22 of which had duodenal ulcers. Among the biopsy specimens obtained from the duodenum of 37 cases, 13 cases (35.1%) had leukocytoclastic vasculitis, neutrophil debri, and/or extravasation of RBCs. Steroid use was more frequent in the duodenal involvement (+) group (86.8%) than the duodenal involvement (−) group (53.8%; p=0.02). The mean length of hospitalization was 13.9±8.43 days in the duodenal involvement (+) group and 8.1±4.62 days in the duodenal involvement (−) group (p=0.003). The recurrence rate was significantly higher in the duodenal involvement (−) group than the duodenal involvement (+) group (p=0.027), whereas none of the other study parameters, such as the age of onset, renal involvement, and steroid use, led to significantly higher or lower recurrence rates. Conclusion: These results suggest that duodenal involvement can influence the clinical course and prognosis of HSP in children. (Korean J Pediatr Gastroenterol Nutr 2009; 12: 156∼162)