From the Guidelines
Celiac axis vasculitis presents with symptoms including abdominal pain, weight loss, nausea, vomiting, and sometimes diarrhea, and treatment typically involves corticosteroids and immunosuppressants, with biological agents considered in severe cases. The condition may also cause malabsorption leading to nutritional deficiencies. Symptoms of celiac axis vasculitis can be non-specific, making diagnosis challenging, but abdominal pain, particularly after eating, is a common complaint 1. Some key points to consider in the management of celiac axis vasculitis include:
- The use of corticosteroids such as prednisone, starting at 40-60mg daily and gradually tapering over several months based on symptom improvement 1.
- The addition of immunosuppressants like methotrexate, azathioprine, or mycophenolate mofetil for maintenance therapy 1.
- The consideration of biological agents such as rituximab or cyclophosphamide in severe cases or those resistant to standard therapy 1.
- Pain management with analgesics and antiemetics for nausea as important supportive measures.
- Regular monitoring of inflammatory markers, complete blood counts, and periodic vascular imaging to assess treatment response 1. The condition requires prompt treatment as untreated celiac axis vasculitis can lead to serious complications including intestinal ischemia, bowel infarction, and even perforation due to compromised blood flow to the digestive organs 1.
From the Research
Symptoms of Celiac Axis Vasculitis
- Abdominal pain localized to the epigastric and periumbilical regions 2
- Nausea 2
- Elevated C-reactive protein and erythrocyte sedimentation rate 2
- Seizures in rare cases, particularly in patients with celiac disease 3
Treatment Options for Celiac Axis Vasculitis
- Oral corticosteroids for a short period, which can lead to symptom resolution and normalization of C-reactive protein levels 2, 4
- Treatment with prednisone and cyclophosphamide in some cases, resulting in clinical and radiographic improvement 3
- Surgical division of the median arcuate ligament to decompress the celiac artery, providing symptomatic relief in cases of median arcuate ligament syndrome (MALS) 5
Diagnosis and Management
- Contrast-enhanced abdominopelvic computed tomography to suggest isolated vasculitis of the celiac artery 2
- Serological tests to show borderline positive anti-nuclear antibodies, while other specific autoantibodies may be negative 2
- Multidisciplinary management involving interventional radiologists, gastrointestinal surgeons, vascular surgeons, and medical physicians 6