Manifestations Of HSP With Gastrointestinal Involvement In Children In Gastroscopy And Relationship Between HSP And Hp Infection

Objective: To investigate manifestations of Henoch-Schonlein purpura (HSP) with gastrointestinal involvement in children in gastroscopy, and relationship between HSP and Helicobacter pylori(Hp) infection.Methods: Sixty-two cases with HSP with gastrointestinal involvement in children were enrolled in the study sequence. All cases were carried on the gastroscope check and 13C Urea breath test(13C-UBT); Who consulted with chief complaint of abdominal pain were carried on the gastroscopy check and then were diagnosed as HSP under the scope were called gastroscopic group, while who consulted with the same complaint were not carried on the check and diagnosed as HSP till the rashes appeared were called control group. The sixty-two cases were as the study group,while another 30 asymptomatic children who were come from the preschool were selected as the control group. Cases with Hp positive were randomly divided into 2 groups, treatment group and control group, cases in the control group were given only conventional therapy, while cases in the treatment group were given a conventional therapy combined with eradication therapy to against Hp. We detected the first misdiagnosis rate, lesions, characters of mucous membrane lesions; and investigated the relationship bewteen gastrointestinal symptoms purpura location and gastroscopic features; Comparison of gastroscopic group and the control group the time of diagnosis and treatment response; Cases complaint of purpura as the first symptom were carried on the gastroscope check, selected treatment protocols according to the changes under the scope; comparison of study group and control group the Hp infection rate, Comparison of treatment group and control group the treatment and relapse rate.Results: There were 31 cases (including one case who was non-purpura) with abdominal pain as their first symptom, 10 cases were first misdiagnosised, the rate was 32.26%. Damages affacted stomach and duodenum mucosa but not the esophagus mucosa; One case who was normal under the scope was given the colonoscopy check, then was found that sigmoid colon and rectum were affected in varying degrees. The gastroendoscopy show that the commonest and most serious position involved was the antrum, duodenal and duodenum. The main gastroduodenal features of HSP were redness of mucosa surface, diffused distribution of bleeding petechiae accompanied with edema and erosion, and ulcers. 12 cases were with bile reflux. The characteristic change is distributed, multi-site bleeding point which was similar to skin purpura. there is no fixed tenderness point and obvious abdominal muscle intension,the degree of abdominal pain is disagree with the sign.We found that more serious the abdominal pain,more bleeding of submucosa. Some serious cases who had histology of the mucosal biopsy (The biopsy was taken in the pathological changeing place: antral and duodenal mucosa) specimens reveals nonspecific inflammation. Main symptoms of gastrointestinal were abdominal pain, vomit, hematochezia, diarrhea and constipation; onset of abdominal pain is with the characteristic of colic and aggravate paroxysmal. There is no fixed tenderness point and obvious abdominal muscle intension,the degree of abdominal pain is disagree with the sign. The degree of abdominal pain is parallel with the change of gastrointestinal tract mucosa. One case in which the entire process has been a rash appears, and the remaining cases of skin rashes located symmetrical over the lower limbs, trunk, upper limbs, buttocks, a small number of cases of facial and auricular skin rash can be seen scattered. Time of diagnosis in gastroscopic group is shorter than in control group (P<0.01) , and treatment response (comparison of when skin rash subsided, pain ease, occult blood negative) in gastroscopic group was significantly better than the control group(P<0.01), hospitalization and hospital costs in gastroscopy group were less than in control group (P<0.01). Cases complaint of purpura as the first symptom were carried on the gastroscope check, 28 cases presented with erosion and ulcer were given the PPI therapy, while those 9 cases presented simple congestion and edema were not. All cases were carried on the 13C Urea breath test, 24 cases undertaken Hp examination were positive, the positivity rate is 38.7%, while the control group is 16.67%. Cases in treatment group had more effective than that in control group(P<0.05). Only one case had relapsed in treatment group, while three cases in control group.Conclusion: 1.Gastroscopy is very helpful for early diagnosis of HSP in children, especially abdominal pain presented precede the rashes. 2.Damages mainly affacted stomach and duodenum mucosa, but few invovment of colon and rectum. Endoscopy demonstrated the damages to the mucosa fluctuated from congestion, edema, petechia, ecchymosis, erosive and multiple ulcers. Many scattered bleeding spots and snowflake-like ulcers on the gastrointestinal mucosa are the most important findings. 3. The HSP cases whose abdominal pain precede the rash were checked up by endoscope, it can shorten the time of diagnosis and had a better treatment response. Those who were complaint of purpura as the first symptom were carried on the gastroscope check, and it is useful for choice of treatment(with or without PPI) according to the changes in the scope. 4.The Changes of gastroscope were more apparent in the cases with Hp positive. Eradication therapy in Hp positive cases may be more effective and less relapse. It states that there is a certain relevance between Hp and HSP.