The Usefulness of Video Capsule Endoscopy in Evaluating Gastrointestinal Manifestations of Immunoglobulin A Vasculitis

Abstract

Objective Immunoglobulin (Ig) A vasculitis (IgAV) is a systemic vasculitis characterized by purpura and gastrointestinal involvement showing abdominal pain that usually occurs after the emergence of purpura. Criteria for evaluating gastrointestinal manifestations of IgAV are unavailable at present, so we conducted a study to investigate the usefulness of video capsule endoscopy (VCE) for detecting gastrointestinal manifestations of IgAV. Methods The clinical data of 10 patients who underwent VCE for IgAV at our hospital from 2012 to 2017 were collected. Nine patients underwent esophagogastroduodenoscopy, and five underwent colonoscopy. We compared the endoscopic severity determined by VCE to the findings of esophagogastroduodenoscopy and colonoscopy. Results The rates of positive findings of esophagogastroduodenoscopy, VCE, and colonoscopy were 56%, 100%, and 80%, respectively. In 70% of cases, the most severe gastrointestinal findings were detected by VCE. VCE was performed on average 16.8 days after the emergence of purpura, and in 8 of 10 patients, its result triggered the initiation of steroid therapy or the control of the steroid dose. Conclusion VCE is very useful for confirming gastrointestinal involvement in IgAV and may be used to determine the timing of steroid therapy initiation. We recommend performing VCE when IgAV is suspected in patients with gastrointestinal symptoms.

Keywords: endoscopic findings; gastrointestinal manifestations; immunoglobulin A vasculitis; steroid therapy; video capsule endoscopy.

Figure 1.

A photograph of the leg purpura (A) and video capsule endoscopy (VCE) images (B and C) of case 2. VCE was performed 8 days after the occurrence of purpura. The VCE images before treatment show circular ulcerations in the small bowel. These findings were the most severe after those in case 6. We graded these findings as grade++.

Figure 2.

A photograph of the leg purpura (A) and video capsule endoscopy (VCE) images (B and C) of case 6. VCE was performed 19 days after the occurrence of purpura. VCE images show circular ulcerations in the small bowel. These findings were the most severe among all of the cases in this study. We graded these findings as grade++.

Figure 3.

A photograph of the leg purpura (A) and video capsule endoscopy (VCE) images (B and C) of case 10. VCE was performed two months after the occurrence of purpura. VCE images show areas of circumferential redness and edema in the jejunum. We graded these findings as grade+.