The demographic features of the patients
There were 30 patients performed VCE examination and was suspected HSP. There were 30 patients enrolled in this study from February 2010 to January 2020. The demographic characteristics of these patients was showed in Table 1. All the patients had GI symptoms, including abdominal pain, vomiting, and intestinal bleeding. Half (15/30) of patients had purpura at admission or during hospitalization. 43.3% (13/30) patients had typical purpura, and two patients were reported to have purpura but not observed by doctor. The GI symptoms and other symptoms of these patients were also shown in Table 1. The complications included hypertension, appendicitis, acute pancreatitis and acute intestinal perforation. A patient with intestinal perforation had surgery. Five patients had a history of HSP previously. And one patient had another episode of HSP a year later.
The laboratory findings of the patients
The laboratory results of these HSP patients were listed in Table 1. Mean count of white blood cells and serum plasm D-dimers levels were elevated, and median CRP and ESR levels were normal.
Images of HSP patients
Fourteen patients had MRE or CT scan of abdominal, and ten patients revealed thickening of the small bowel. Other patients did not show inflammation of small bowel.
The features of endoscopy finding.
All the patients had EGD examination and obtained biopsy at duodenum and gastric antrum. Among them, 27 patients had first EGD in our hospital, three patients had EGD in other hospitals before admission, and one patient had second EGD in our hospital. No typical traits of HSP were detected by the EGD examination in 19 patients. One patient revealed duodenum ulcers by first EGD examination at the acute stage of diseases, while the second EGD examination in our hospital five months later was normal. The most frequent findings of EDG were mucosal ecchymosis, petechiae, erosion, and multiple ulcers. EGD revealed typical traits of HSP in the descending of the duodenum in nine patients. Two patients had the whole stomach involved, and one also had the lower part of the esophagus involved. Thirteen patients performed colonoscopy, and two patients detected ulcers in the terminal ileum, and one patient detected a polyp in the colon, which considered as comorbidity.
Thirty patients had VCE examination. The capsule did not pass through pylorus in one patient, and the others all went through the whole small bowel. The median time of the VCE examination was 21.0 days (IQR: 13.8 to 36.0) after the initial symptoms of HSP appeared. VCE detected multiple mucosal ecchymosis, erosion, and irregular superficial ulcers, which resembled the findings of EGD in 27 patients. Moreover, some patients with massive intestinal bleeding tend to have diffuse erosion and large areas of ulcers (Fig 1). The numbers and percentage of different lesions identified by VCE were listed in Table 2. One male patient had massive intestinal bleeding, and intestinal perforation was treated with surgery and followed with oral methotrexate (MTX). He had a VCE examination to assess the recovery of intestinal lesion eight months after the onset of disease onset, and the VCE only detected mucosal congestion in the jejunum. The disease location of patients detected by endoscopy was shown in Table 3. The most frequently involved disease location in this cohort was jejunum, which account for 96.7 % of the patients, and followed by the descending part of the duodenum which was accounts for 33.3 %. None of these patients affected colon. There was no retention or other side effect observed in this study.
The EGD, VCE, and colonoscopy findings of HSP patients with or without skin purpura were shown in Table 4.
Treatment
90 % (27/30) of the patients were initially treated by steroids, and another three patients received PPI or montelukast for unremarkable gastrointestinal symptoms. Four patients were treated by immunoglobin combined with steroids, and seven patients were treated by immunosuppressants, because they were not completely responsive to steroids or dependent on steroids. One patient with intestinal perfusion had surgery and then treated with methotrexate for two months. All the patients were followed in our hospital and were completely recovered.