Presentation and outcome of gastrointestinal involvement in hepatitis C virus-related systemic vasculitis: a case–control study from a single-centre cohort of 163 patients

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http://gut.bmj.com/content/early/2010/09/14/gut.2010.218123

Gut doi:10.1136/gut.2010.218123

Paper

Presentation and outcome of gastrointestinal involvement in hepatitis C

virus-related systemic vasculitis: a case–control study from a single-centre

cohort of 163 patients

Terrier1,2, Saadoun1,2, Damien Sène1, Sami Scerra1, Lucile

Musset3, Patrice Cacoub1,2

+ Author Affiliations

1Department of Internal Medicine, Groupe Hospitalier Pitié-Salpétrière,

Université Pierre et Marie Curie, Paris, France

2CNRS UMR 7211, Groupe Hospitalier Pitié-Salpétrière, Université Pierre et

Marie Curie, Paris, France

3Department of Immunology, Groupe Hospitalier Pitié-Salpétrière, Université

Pierre et Marie Curie, Paris, France

Correspondence to

Professor Patrice Cacoub, Department of Internal Medicine, Groupe Hospitalier

Pitié-Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France;

patrice.cacoub@...

Contributors BT and PC design the study, analysed the data and wrote the paper.

D. Saadoun, D. Sène, SS and LM participated to the acquisition of data and the

follow-up of patients.

Revised 24 June 2010

Accepted 15 July 2010

Published Online First 14 September 2010

Abstract

Background During primary systemic vasculitides gastrointestinal (GI)

involvement is associated with a poor outcome, leading to the use of

immunosuppressive therapy. The significance of GI involvement during hepatitis C

virus (HCV)-related systemic vasculitis has never been evaluated.

Objective To evaluate the significance of GI involvement during HCV-related

systemic vasculitis in the antiviral therapy era.

Methods Data from 163 patients were retrospectively reviewed to describe the

presentation and outcome of patients with HCV-related systemic vasculitis with

GI involvement (GI+), and to compare them with patients without GI involvement

(GI−).

Results GI manifestations were present in 12 (7.4%) patients. Abdominal pain was

consistently present in GI+ patients, and half of patients presented with

surgical abdomen and/or intestinal bleeding. GI+ compared to GI− patients had

more frequent renal (75% vs 30%; p=0.003) and cardiac involvement (25% vs 2%;

p=0.006), medium-vessel vasculitis (67% vs 22%; p=0.003) and higher mixed

cryoglobulinaemia levels (2.2 g/l vs 1.2 g/l; p=0.07). After treatment, GI+ and

GI− patients had similar rates of overall clinical response of the vasculitis

and immunological and virological responses. HCV-MC vasculitis patients with GI

involvement did not have poorer overall survival than those without.

Conclusion GI involvement is a rare manifestation of HCV-related vasculitis,

associated with acute-onset and life-threatening manifestations. In contrast

with primary vasculitides, GI+ patients do not seem to have poorer overall

survival than GI− patients