Gastrointestinal manifestations in adult IgA vasculitis over 8.5 years: severity assessment and therapeutic outcomes.
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INTRODUCTION: IgA vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is a small-vessel systemic vasculitis predominantly affecting children. In adults, IgAV is a rare disease; gastrointestinal (GI) involvement is nonetheless more frequent and severe than in the pediatric population, significantly impacting short-term prognosis. Data on GI manifestations in adult IgAV remain limited, and therapeutic management is not well codified. METHODS: we conducted a descriptive observational study of adult patients (≥16 years) diagnosed with IgAV according to the 1990 American College of Rheumatology (ACR) or the 2012 Chapel Hill Consensus Conference (CHCC) criteria, admitted to the Internal Medicine Department of Farhat Hached University Hospital, Sousse, over the years. Gastrointestinal involvement was defined by clinical manifestations combined with at least one objective criterion (imaging or endoscopic/histological findings). Clinical and radiological severity were assessed using the Trouillier scoring system. Prolonged remission was defined as the absence of GI symptoms for at least six months after completion of corticosteroid therapy. RESULTS: among 30 patients diagnosed with IgAV, twenty-nine patients were included in the primary analysis (mean age: 45.6±18.1 years; gender ratio: 0.87) and one patient with concurrent gastric MALT lymphoma was analyzed separately. Gastrointestinal involvement occurred in 20 patients (66.7%). The most common symptom was abdominal pain (100%), followed by vomiting (70%) and GI bleeding (40%). Severe disease was identified in 45% by clinical scoring and in 39% by radiological assessment. Corticosteroid therapy achieved prolonged remission in 63% of patients. Male gender showed a non-significant trend toward increased GI involvement (p=0.058). CONCLUSION: gastrointestinal manifestations in adult IgAV are frequent and often severe. The low patient accrual rate (3.5 cases/year) reflects the rarity of IgAV in adults, a disease predominantly affecting children.