Gastrointestinal Involvement in Adult IgA Vasculitis: A Comprehensive Review

Immunoglobulin A vasculitis (IgAV), formerly Henoch-Schönlein purpura (HSP), is a small-vessel vasculitis with IgA (immunoglobulin A) immune complex deposition that predominantly affects the skin, joints, kidneys, and gastrointestinal (GI) tract. While less common in adults than in children, IgAV (immunoglobulin A vasculitis) is more severe and less well-characterized in adults. GI involvement in adults is associated with significant morbidity, motivating a comprehensive understanding of IgAV pathophysiology, diagnosis, and management. We synthesized current literature on adult IgAV with GI involvement, including its epidemiology, immune mechanisms, genetic drivers, diagnostic approaches, treatment modalities, and prognostic factors. The pathogenesis of IgA vasculitis involves immune complex-mediated small-vessel inflammation driven by aberrant IgA responses, proinflammatory cytokines, genetic predisposition, and environmental triggers. GI involvement occurs in 37-65% of adult IgAV cases, with symptoms ranging from abdominal pain and hematochezia to severe complications such as perforation and ischemia. Diagnosis relies on measurement of laboratory markers (elevated C-reactive protein, Neutrophil-to-Lymphocyte ratio, D-dimer) and imaging (computed tomography, endoscopy). Treatment includes corticosteroids for moderate-to-severe cases, with immunosuppressants (mycophenolate mofetil, intravenous immunoglobulins) reserved for refractory cases. Surgical intervention is rare but necessary in cases of life-threatening complications. Prognostic factors include age, renal involvement, and genetic markers. Adult GI IgAV requires early recognition and a multidisciplinary approach for effective management. Future research should explore advanced biomarkers and therapeutic strategies to improve outcomes.