Rheumatology International

, Volume 39, Issue 2, pp 317–322 | Cite as

Is Henoch–Schönlein purpura a susceptibility factor for functional gastrointestinal disorders in children?

  • Rabia Miray Kisla EkinciEmail author
  • Sibel Balcı
  • Okkes Ozgur Mart
  • Gokhan Tumgor
  • Sibel Yavuz
  • Halil Celik
  • Dilek Dogruel
  • Derya Ufuk Altintas
  • Mustafa Yilmaz


Henoch–Schönlein purpura (HSP), the most common childhood vasculitis is characterized by non-thrombocytopenic palpable purpura, arthritis/arthralgia, abdominal pain and renal involvement. Functional gastrointestinal disorders (FGIDs) are heterogeneous disease spectrum with unclear etiology and include the most common subtypes: functional dyspepsia, irritable bowel syndrome (IBS), functional abdominal pain and functional constipation. Formerly, FGIDs were known as non-organic disorders; however, recent advances revealed that low-grade inflammation may also play a role. We aimed to clarify whether HSP predisposes to FGIDs in pediatric population. Seventy-four children with HSP, diagnosed at least 6 months before the study and 78 healthy controls were enrolled to the study. Patients with red flag signs for organic GI disorders were excluded. Rome IV criteria were utilized for FGIDs diagnosis. We compared the frequencies of FGIDs between HSP patients and healthy subjects. We also examined the parameters including age, abdominal pain, arthralgia, bloody stool, renal involvement and treatment with corticosteroids and laboratory results at HSP diagnosis such as erythrocyte sedimentation rate, C-reactive protein, hemoglobin, leukocytes and platelet counts among patients with and without FGIDs. Overall FGIDs and IBS frequency were 35.1% (n = 26) and 10.8% (n = 8) in HSP patients, 19.2% (n = 15) and 2.6% (n = 2) in healthy controls, respectively. Disease characteristics and laboratory parameters at disease onset were similar between HSP patients with and without FGIDs. Overall FGIDs rate, particularly IBS were statistically higher in HSP patients. We speculate that children with preceding HSP may be predisposed to FGIDs. Since the FGIDs pathogenesis is still remains unclear, further studies are needed to confirm this hypothesis and clarify the etiology. Physicians also should pay attention to FGIDs in HSP patients with ongoing abdominal pain and thus prevent this comorbidity with dietary and psychologic measures.


Henoch–Schönlein purpura Child Functional gastrointestinal disorder Abdominal pain Constipation Irritable bowel syndrome 


Author contributions

Dr. RMKE and Dr. MY conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. SB, Dr. GT, Dr. SY and Dr. DD collected data, carried out the initial analyses, and reviewed and revised the manuscript. Dr. DUA, Dr. OOM and Dr. HC designed the data collection instruments, and coordinated and supervised data collection, and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


No funding was received.

Compliance with ethical standards

Conflict of interest

Authors Rabia Miray Kisla Ekinci, Sibel Balci, Okkes Ozgur Mart, Gokhan Tumgor, Sibel Yavuz, Halil Celik, Dilek Dogruel, Derya Ufuk Altintas, Mustafa Yilmaz declare that they have no conflicts of interest.


  1. 1.
    Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, Flores-Suarez LF, Gross WL, Guillevin L, Hagen EC, Hoffman GS, Jayne DR, Kallenberg CG, Lamprecht P, Langford CA, Luqmani RA, Mahr AD, Matteson EL, Merkel PA, Ozen S, Pusey CD, Rasmussen N, Rees AJ, Scott DG, Specks U, Stone JH, Takahashi K, Watts RA (2013) 2012 revised international chapel hill consensus conference nomenclature of vasculitides. Arthritis Rheum 65:1–11. CrossRefGoogle Scholar
  2. 2.
    Trnka P (2013) Henoch-Schönlein Purpura in children. J Paediatr Child Health 49:995–1003. CrossRefGoogle Scholar
  3. 3.
    Heineke MH, Ballering AV, Jamin A, Ben Mkaddem S, Monteiro RC, Van Egmond M (2017) New insights in the pathogenesis of immunoglobulin A vasculitis (Henoch-Schönlein Purpura). Autoimmun Rev 16:1246–1253. CrossRefGoogle Scholar
  4. 4.
    Mossberg M, Segelmark M, Kahn R, Englund M, Mohammad AJ (2018) Epidemiology of primary systemic vasculitis in children: a population-based study from southern Sweden. Scand J Rheumatol 47:295–302. CrossRefGoogle Scholar
  5. 5.
    Soowamber M, Weizman AV, Pagnoux C (2017) Gastrointestinal aspects of vasculitides. Nat Rev Gastroenterol Hepatol 14:185–194. CrossRefGoogle Scholar
  6. 6.
    Hetland LE, Susrud KS, Lindahl KH, Bygum A (2017) Henoch-Schönlein Purpura: a literature review. Acta Dermatovenereol 97:1160–1166. Google Scholar
  7. 7.
    Boronat AC, Ferreira-Maia AP, Matijasevich A, Wang YP (2017) Epidemiology of functional gastrointestinal disorders in children and adolescents: a systematic review. World J Gastroenterol 23:3915–3927. CrossRefGoogle Scholar
  8. 8.
    Koloski NA, Talley NJ, Boyce PM (2002) Epidemiology and health care seeking in the functional GI disorders: a population-based study. Am J Gastroenterol 97:2290–2299CrossRefGoogle Scholar
  9. 9.
    Keely S, Walker MM, Marks E, Talley NJ (2015) Immune dysregulation in the functional gastrointestinal disorders. Eur J Clin Investig 45:1350–1359. CrossRefGoogle Scholar
  10. 10.
    Saps M, Dhroove G, Chogle A (2011) Henoch-Schonlein Purpura leads to functional gastrointestinal disorders. Dig Dis Sci 56:1789–1793. CrossRefGoogle Scholar
  11. 11.
    Börekci E, Celikbilek M, Soytürk M, Akar S, Börekci H, Günaydin I (2017) Functional gastrointestinal disorders in patients with familial Mediterranean fever. Int J Rheum Dis 20:2101–2105. CrossRefGoogle Scholar
  12. 12.
    García-Carrasco M, Mendoza-Pinto C, Autrán-Limón MA, Herrera Robles E, Méndez Martínez S, Etchegaray Morales I, Montiel Jarquín Á, Gálvez Romero JL, Soto-Santillán P, Galindo-Herrera J, López-Colombo A (2018) Prevalence of functional gastrointestinal disorders in adults with systemic lupus erythematosus. Lupus 27:788–793. CrossRefGoogle Scholar
  13. 13.
    Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R et al (2010) EULAR/PRINTO/PRES criteria for Henoch-Schönlein Purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: final classification criteria. Ann Rheum Dis 69:798–806CrossRefGoogle Scholar
  14. 14.
    Rajindrajith S, Zeevenhooven J, Devanarayana NM, Perera BJC, Benninga MA (2018) Functional abdominal pain disorders in children. Expert Rev Gastroenterol Hepatol 12:369–390. CrossRefGoogle Scholar
  15. 15.
    Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M (2016) Functional disorders: children and adolescents. Gastroenterology. Google Scholar
  16. 16.
    Saps M, Adams P, Bonilla S, Chogle A, Nichols-Vinueza D (2012) Parental report of abdominal pain and abdominal pain-related functional gastrointestinal disorders from a community survey. J Pediatr Gastroenterol Nutr 55:707–710. CrossRefGoogle Scholar
  17. 17.
    Lewis ML, Palsson OS, Whitehead WE, van Tilburg MAL (2016) Prevalence of functional gastrointestinal disorders in children and adolescents. J Pediatr 177:39–43.e3. CrossRefGoogle Scholar
  18. 18.
    Akiho H, Ihara E, Nakamura K (2010) Low-grade inflammation plays a pivotal role in gastrointestinal dysfunction in irritable bowel syndrome. World J Gastrointest Pathophysiol 1:97–105CrossRefGoogle Scholar
  19. 19.
    Chen J, Zhang Y, Deng Z (2012) Imbalanced shift of cytokine expression between T helper 1 and T helper 2 (Th1/Th2) in intestinal mucosa of patients with post-infectious irritable bowel syndrome. BMC Gastroenterol 12:91. CrossRefGoogle Scholar
  20. 20.
    Wang LH, Fang XC, Pan GZ (2004) Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis. Gut 53:1096–1101. CrossRefGoogle Scholar
  21. 21.
    Bercik P, Verdu EF, Collins SM (2005) Is irritable bowel syndrome a lowgrade inflammatory bowel disease? Gastroenterol Clin N Am 34:235–245 vi-vii.CrossRefGoogle Scholar
  22. 22.
    Myasoedova E, Talley NJ, Manek NJ, Crowson CS (2011) Prevalence and risk factors of gastrointestinal disorders in patients with rheumatoid arthritis: results from a population-based survey in Olmsted county, Minnesota. Gastroenterol Res Pract. Google Scholar
  23. 23.
    Baysoy G, Güler-Baysoy N, Kesicioğlu A, Akın D, Dündar T, Pamukçu-Uyan A (2014) Prevalence of irritable bowel syndrome in adolescents in Turkey: effects of gender, lifestyle and psychological factors. Turk J Pediatr 56:604–611Google Scholar
  24. 24.
    Del Vecchio GC, Penza R, Altomare M, Piacente L, Aceto G, Lassandro G, De Mattia D, Giordano P (2008) Cytokine pattern and endothelium damage markers in Henoch-Schönlein Purpura. Immunopharmacol Immunotoxicol 30:623–629. CrossRefGoogle Scholar
  25. 25.
    Ha TS (2005) The role of tumor necrosis factor-alpha in Henoch-Schonlein Purpura. Pediatr Nephrol 20:149–153. CrossRefGoogle Scholar
  26. 26.
    De Angelis M, Montemurno E, Piccolo M, Vannini L, Lauriero G, Maranzano V, Gozzi G, Serrazanetti D, Dalfino G, Gobbetti M, Gesualdo L (2014) Microbiota and metabolome associated with immunoglobulin A nephropathy (IgAN). PLoS One 9:e99006. CrossRefGoogle Scholar
  27. 27.
    Wang X, Zhang L, Wang Y, Liu X, Zhang H, Liu Y, Shen N, Yang J, Gai Z (2018) Gut microbiota dysbiosis is associated with Henoch-Schönlein Purpura in children. Int Immunopharmacol 58:1–8. CrossRefGoogle Scholar
  28. 28.
    Coss-Adame E, Rao SS (2014) Brain and gut interactions in irritable bowel syndrome: new paradigms and new understandings. Curr Gastroenterol Rep 16:379. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatric RheumatologyCukurova University Faculty of MedicineAdanaTurkey
  2. 2.Department of PediatricsCukurova University Faculty of MedicineAdanaTurkey
  3. 3.Department of Pediatric GastroenterologyCukurova University Faculty of MedicineAdanaTurkey
  4. 4.Department of Pediatric Allergy and ImmunologyCukurova University Faculty of MedicineAdanaTurkey

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