Analysis Of Clinical Manifestations And Gastroscopic Characteristics Of Children With Abdominal Anaphylactoid Purpura

Objective To investigate the clinical manifestations and gastroscopic characteristics of abdominal Henoch-Sch(?)nlein purpura(HSP),and to further explore the relationship between the severity of mucosal damage under gastroscopy and the relevant clinical manifestations,to provide a reference for clinical disease assessment and early diagnosis and treatment.Methods Retrospectively analyzed the clinical data of 96 children with abdominal HSP who underwent gastroscopy from May 2018 to May 2022 at the Hospital.According to the presence or absence of bleeding and/or ulcers under gastroscopy,the 96 children were divided into two groups: mild and severe,and compared the relevant clinical features between the two groups.Results1.A total of 96 children with abdominal HSP who underwent gastroscopy were included in this study,including 59 males and 37 females,with a male-to-female ratio of1.59:1.00.The age range was 3 to 16 years.All patients had typical skin rash and/or varying degrees of abdominal pain during the course of the disease,and some had symptoms such as bloody stools,joint pain,vomiting,hematemesis,and edema.2.Laboratory tests showed that most patients had elevated peripheral white blood cell counts,C-reactive protein(CRP),platelet counts,and D-dimer levels.Some patients also had positive stool occult blood,red blood cells and protein in the urine.3.Abdominal ultrasound showed segmental intestinal wall edema and thickening at different sites and degrees,as well as varying degrees of free fluid in the intestinal mesentery,abdominal cavity and pelvic cavity.4.Under gastroscopy,the main manifestations were varying degrees of congestion,edema,roughness,erosion,erythema,bleeding,and ulcers in the gastric and duodenal mucosa,often with multiple lesions appearing simultaneously.Typical lesions were mainly concentrated in the gastric antrum and duodenal mucosa,and the characteristic endoscopic appearance was multiple erythematous hemorrhagic mucosal lesions.Gastric mucosal involvement was more common in the gastric antrum,but the severity was not as high as that in the duodenal mucosa,and the involvement of the descending part of the duodenum was more severe.In this study,13 cases(13.54%)were diagnosed based on characteristic mucosal changes under gastroscopy before the appearance of typical skin rash,and these patients benefited significantly from the gastroscopic examination.5.There was no statistically significant difference(P>0.05)in the comparison of relevant clinical features such as the time of significant relief of abdominal pain after admission,length of hospital stay,gastrointestinal symptoms as the presenting symptom,vomiting,hematemesis,bloody stools/melena,joint involvement,and renal involvement during hospitalization between the two groups of patients with mild and severe mucosal damage.6.Pathological histological biopsy showed mostly nonspecific inflammation,and typical pathological changes in gastric or duodenal mucosal tissue showed infiltration of lymphocytes,neutrophils,and eosinophils.Conclusion1.The main endoscopic manifestations of abdominal HSP were varying degrees of congestion,edema,roughness,erosion,erythema,bleeding,and ulcers in the gastric and duodenal mucosa,often with multiple lesions appearing simultaneously.Typical lesions were mainly concentrated in the gastric antrum and duodenal mucosa,and the characteristic endoscopic appearance was multiple erythematous hemorrhagic mucosal lesions.2.Gastroscopic examination is of great significance for the early diagnosis of abdominal HSP in children(with gastrointestinal symptoms as the initial symptoms,and typical skin rash has not yet appeared).3.There was no correlation between the severity of mucosal injury and the related clinical manifestations under gastroscopy.