Helicobacter pylori-Independent Gastric Mucosal Lesions Associated with Systemic Disorders―Crohn's Disease, Polyarteritis Nodosa, Schoonlein-Henoch Purpura, Tuberous Sclerosis, and Graft-Versus-Host Disease Hideki Koga 1,2 , Ken Haruma 1 , Ken-ichi Tarumi 1 , Kayoko Shimizu 1 , Hiroshi Matsumoto 1 , Tomoari Kamada 1 , Hiroaki Kusunoki 1 , Masaharu Takeda 1 , Keisuke Honda 1 , Takayuki Matsumoto 2 , Mitsuo Iida 2 1Division of Gastroenterology, Department of Medicine, Kawasaki Medical School, Kurashiki, Japan 2Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Keyword: Crohn病 , 結節性多発動脈炎 , Schoonlein-Henoch紫斑病 , 結節性硬化症 , 移植片対宿主病 pp.1033-1044
Published Date 2006/6/25
DOI https://doi.org/10.11477/mf.1403100803
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 Various systemic disorders are known to involve the gastrointestinal tract. Gastrointestinal lesions often develop in the small or large intestine, and gastric mucosal lesions independent of Helicobacter pylori infection are rarely identified. Therefore, we reviewed gastric involvement in the following five disorders : Crohn's disease, polyarteritis nodosa,Schoonlein-Henoch purpura, tuberous sclerosis, and graft-versus-host disease.

 In Crohn's disease, aphthoid lesions at the antrum were seen in one third of the patients examined. Gastric ulcers were rare and their clinical courses were atypical. A bamboo joint-like appearance of the cardia, which may be only a morphological change in the gastric mucosa, was observed in 79% of the patients and seems to be suitable as an indication for screening the condition because of high sensitivity and high specificity.

 In arteritis nodosa, gastric lesions, which were mostly multiple gastric ulcers refractory to medication, were seen in approximately 20% of the patients.

 Schoonlein-Henoch purpura mainly develops in children. We presented a case of Schoonlein-Henoch purpura in an elderly subject. Recently, there have been some reports suggesting a causal relationship between Helicobacter pylori and Schoonlein-Henoch purpura. We also presented a case of Schoonlein-Henoch purpura in which Schoonlein-Henoch purpura gastritis was superimposed on Helicobacter pylori-associated nodular gastritis.

 As a rare gastrointestinal manifestation in tuberous sclerosis, hamartomatous polyposis of the stomach was demonstrated in our case.

 Although patients with graft-versus-host disease frequently complain of gastrointestinal symptoms from the early stage, gastric involvement in chronic graft-versus-host disease remains unclear. We presented interesting images of gastric lesions in a patient with chronic graft-versus-host disease.

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