Comparison of the Clinical Manifestations and Prognosis of Henoch-Schonlein Purpura in Children with and without Abdominal Pain

Sungwoo Kim; Jungwon Yoon; Sujin Jeong

doi:10.5223/kjpgn.2011.14.4.359

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Kim, Yoon, and Jeong: Comparison of the Clinical Manifestations and Prognosis of Henoch-Schonlein Purpura in Children with and without Abdominal Pain

Original Article

Gastrointestinal Tract

Korean Journal of Pediatric Gastroenterology and Nutrition

Korean Journal of Pediatric Gastroenterology and Nutrition 2011; 14(4): 359-367.

Published online: 31 December 2011

DOI: https://doi.org/10.5223/kjpgn.2011.14.4.359

Comparison of the Clinical Manifestations and Prognosis of Henoch-Schonlein Purpura in Children with and without Abdominal Pain

Sungwoo Kim, B.S., Jungwon Yoon, B.S., Sujin Jeong, M.S.

Department of Pediatrics, CHA Bundang Medical Center, CHA University of Medicine, Seongnam, Korea.

Corresponding author: Tel: 031-780-5230, Fax: 031-781-1901, (jinped@hanmail.net)

Received 5 September 2011 Revised 22 October 2011 Accepted 24 October 2011

Abstract

Purpose

We compared the clinical manifestations and prognosis of Henoch-Schonlein Purpura (HSP) in children with and without abdominal pain to investigate the usefulness of endoscopy.

Methods

We retrospectively studied 185 HSP inpatients (group A [with abdominal pain] and group N [without abdominal pain]) who had been admitted to the BundangCHA hospital between 2001 and 2010. We compared clinical manifestations, laboratory findings and endoscopic and ultrasonographic findings.

Results

Of the 185 children, 112 (60.5%) had abdominal pain and 31 (16.8%) presented with abdominal pain before developing cutaneous purpura. Group A patients were older (6.9±3.5 vs. 5.3±3.3 years), had higher rates of positive results for stool occult blood (53.8%, p<0.001), and had longer hospital stays (5.2±4.2 vs. 3.6±2.5 days) than group N patients. Group A had a higher frequency of renal involvement than group N on admission (p=0.047). Ultrasonography showed small bowel wall thickening in 31 cases (43.7%) and increased Doppler flow in the bowel wall in 22 cases (31%) in Group A. Upper gastrointestinal endoscopy revealed HSP - related lesions in the stomach (25 cases) and duodenum (19 cases). The second portion of the duodenum was a more common lesion site than the duodenal bulb. Ultrasonography showed abnormalities in 13 of 19 patients with duodenal lesions. Recurrence was more common in Group A.

Conclusion

These results suggest that recurrence and renal involvement are more common in HSP patients with abdominal pain. Upper gastrointestinal endoscopy could be a useful diagnostic tool for HSP patients who develop abdominal pain before cutaneous purpura.

Keywords: Henoch-Schonlein Purpura, Ultrasonography, Endoscopy, Abdominal pain

Figures and Tables

Fig. 1

The incidence of abnormal findings on upper gastrointestinal endoscopy in patients with HSP. A1: HSP with abdominal pain before cutaneous purpura in group A, A2: HSP with purpura before abdominal pain in group A, Eso: esophagus, St: stomach, D. bulb: duodenal bulb, D. 2nd: duodenal second portion.

Table 1

Clinical Characteristics of Patients with Henoch-Schonlein Purpura

A: HSP with abdominal pain, A1: HSP with abdominal pain ahead of cutaneous purpura in group A, A2: HSP with purpura ahead of abdominal pain in group A, N: HSP without abdominal pain, M: male, F: female. ^*Comparison between Groups A and N.

Table 2

Laboratory Findings of Patients with Henoch-Schonlein Purpura

A: HSP with abdominal pain, N: HSP without abdominal pain, Occult stool blood (P/N): positive numbers/tested numbers of patients.

Table 3

Ultrasonographic Findings of Henoch-Schonlein Purpura with Abdominal Pain

A1: HSP with abdominal pain before cutaneous purpura in group A, A2: HSP with purpura before abdominal pain in group A.

Table 4

Clinical Manifestations of Patients for 6 Months after Discharge (n=133)

A: HSP with abdominal pain, N: HSP without abdominal pain.

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