Vasculitis and the gastrointestinal tract

Vasculitis, defined as a non-infectious inflammatory disorder of blood vessels, can affect vessels of any type in any organ. The gas- trointestinal (GI) tract may thus also be involved. In systemic dis- orders as mixed connective tissue disease (MCTD) and systemic lupus erythematodes (SLE), patients may present with symptoms of gastrointestinal disfunction such as motility disorders, caused by alterations in the connective tissue. True vasculitis however also occurs in the GI tract. Severe, occlusive damage often leads to ischemia that may result in ulceration and perforation. Non-occlu- sive vascular disease may lead to vascular leakage resulting in oedema and haemorrhage. Those patients often present with diar- rhoea or symptoms of bleeding. GI involvement is frequent in Henoch-Schönlein purpura and also often noted in polyarteritis nodosa (PAN), microscopic polyangiitis, Wegener's syndrome and Churg-Strauss syndrome. Furthermore, GI vasculitis has also been described in giant cell arteritis, Takayasu's disease, Buerger's disease and leucocytoclas- tic vasculitides as essential mixed cryoglubulinemia, lupus vasculi- tis, rheumatoid disease, MCTD, drug-induced vasculitis and Behçet's disease. The diagnosis and classification of vasculitis relies upon a combination of clinical, serological, haematological, radiological and histological findings. Establishing a precise diag- nosis can be difficult but is important because treatment and prog- nosis can be highly variable. (Acta gastroenterol. belg., 2002, 65, 204-212).