Gastrointestinal involvement in granulomatosis with polyangiitis is uncommon but carries significant prognostic implications, according to a retrospective cohort study. The findings suggest that patients with gastrointestinal manifestations experience more severe disease, earlier relapse, and substantially higher mortality than those without gastrointestinal involvement.
Frequency and Spectrum of Gastrointestinal Manifestations
The study reviewed clinical records from 220 patients with a confirmed diagnosis of granulomatosis with polyangiitis who were treated at a tertiary referral center between 2013 and 2021. Gastrointestinal involvement was identified in 18 patients, representing 8.2% of the cohort.
Reported gastrointestinal manifestations were diverse and included hepatitis, mesenteric ischemia, diarrhea, pancreatitis, and elevated liver enzymes. Although relatively infrequent, these features often reflected systemic disease activity rather than isolated organ involvement.
Association With Disease Severity and Relapse
Patients with gastrointestinal involvement demonstrated significantly higher disease activity at presentation, as measured by the Birmingham Vasculitis Activity Score. Mean BVAS scores were 21 in patients with gastrointestinal involvement compared with 15.8 in those without, highlighting a more aggressive disease phenotype.
Clinical outcomes were also notably worse. Time to first relapse was significantly shorter among patients with gastrointestinal manifestations, with relapse occurring at a mean of 5.2 months compared with 10.3 months in patients without gastrointestinal involvement. These findings indicate diminished treatment durability and increased disease instability in this subgroup.
Increased Mortality Risk and Clinical Implications
The presence of gastrointestinal involvement was associated with a markedly increased risk of death. Patients with gastrointestinal manifestations had more than a threefold higher mortality risk compared with those without gastrointestinal involvement, underscoring the serious prognostic impact of these features.
The authors emphasise that early recognition of gastrointestinal symptoms in granulomatosis with polyangiitis may be critical for risk stratification and management. Prompt evaluation and aggressive treatment strategies may help mitigate complications and improve outcomes in this high-risk population. Further prospective studies are needed to clarify underlying mechanisms and define optimal therapeutic approaches.
Reference
Siri G et al. Gastrointestinal involvement in granulomatosis with polyangiitis: frequency, clinical impact, and prognostic implications in a retrospective cohort study. BMC Rheumatol. 2025;DOI: 10.1186/s41927-025-00585-w.
