Spectrum of gastrointestinal involvement in Stevens - Johnson syndrome

Table 1 Reported cases of Stevens - Johnson syndrome or toxic epidermal necrolysis with gastrointestinal involvement

Ref.	Age (yr), Sex	TBSA (%)	GI Symptoms	Extent of GI involvement/Complications	Treatment	Outcome
[21]	71, F	30	GI bleed, D	(1) Ileus, Intraabdominal abscess, Jejunal perforation, Gastiric/colonic ulcer; (2) LA grade C esophagitis	(1) Steroid, IVIg; (2) Plasmapheresis; (3) Surgery	Survived (LOS-2 mo)
[14]	74, M	40	-	Intestinal perforation	Steroid, IVIg	Expired (after 31 d)
[22]	44, F	0	GI bleed	Gastric/rectal erosions	Steroid	Survived (LOS-31 d)
[23]	62, F	> 30	AP, V	Intestinal infarction	Intestinal resection	Expired (after few days)
[24]	28, M	90	AD	Mesentric ischaemia	(1) IVIg; (2) Jejeunal-ileal resection	Survived (LOS-10 d)
[25]	56, F	60	D, Hypoalbumenia	Esophageal/duodenal/ileocolonic erosions	Steroid, IVIg, TPN	Survived
[26]	61, F	-	Odynophagia, GI bleed	Esophageal/recto-sigmoid ulcers	Steroid	Survived (LOS-1 mo)
[27]	23, M	-	AP,D, GI bleed	Colonic ulcers	Steroid, Probiotics	Survived (DOI-2 mo)
[28]	8, M	40	V, AD, D	Ileoileal intussusception	Surgery	Survived (LOS-15 d)
[29]	71, F	95	AD, D, GI bleed	Esophageal/gastric/sigmoid colonic erosions	IVIg	Expired (after 24 h)
[30]	30, F	61	D, GI bleed	Jejunal/colonic ulcers	Steroid, TPN, PE	Survived (DOI-5 mo)
[31]	52, F	> 30	D, GI bleed	Ileocolonic stenosis	Ileo-cecal resection	Survived
[32]	17, M	73	D, GI bleed	(1) Microscopic duodenitis; (2) Ileocolonic ulcerations	Steroid, TPN, EN, Probiotics	Survived (DOI-6 mo)
[33]	62, M	70	Massive GI bleed	Confluent esophago-gastroduodenal ulceration	Steroids	Expired (after 21 d)
[34]	81, F	40	Jaundice	Mucosal erosions in upper GI tract	IVIg	Survived (LOS-14 d)
[35]	46, F	> 75	D, GI bleed	Mucosal sloughs/ulcers (autopsy)	Steroids, Cyclophosphamide	Expired (LOS-9 mo)
[36]	48, F	40	D, malabsorption, protein-losing enteropathy	(1) Gastritis; (2) Multiple ileal strictures; (3) Multiple pseudodiverticular sacs; (4) Pseudomembranes formation	TPN, Ileal resection	Survived (LOS > 9 mo)
[12]	69, F	37	AP, GI bleed	(1) Sigmoid colon ulcers; (2) Perforations (sigmoid colon, cecum); (3) Ileal necrosis	Steroids, Ileal resection/ colectomy	Survived (LOS-5 mo)
[11]	4 cases (mean 42 (3F:1M)	Mean 37	AP and GI bleed in all	(1) Duodenitis (2 cases); (2) Oesophagitis (1 case); (3) Procosigmoiditis (4 cases); (4) Jejunoileal involvement (1 case)	Ileal resection (1case)	Expired (3 cases), Survived (1 case)
[37]	41, F	> 70	AP, D, GI bleed	(1) Gastroduodenitis; (2) Sigmoiditis	Steroid	Expired (after 15 d)
[38]	53, F	> 75	AP, D	Small bowel ulcers	Steroid	Expired (after 17 d)
[39]	48, F	-	AP, D, GI bleed	Subacute intestinal obstruction	Steroid	Expired (after 8 hrs)

TBSA: Total body surface area; GI: Gastrointestinal; M: Male; F: Female; TPN: Total parenteral nutrition; LOS: Length of stay; D: Diarrhea; V: Vomiting; AP: Abdominal pain; AD: Abdominal distension; IVIg: Intravenous immunoglobulin; PE: Plasma exchange; EN: Enteral nutrition; DOI: Duration of illness.

Table 2 Spectrum of gastrointestinal involvement in Stevens - Johnson syndrome or total parenteral nutrition

Total reported cases	25
Age (range)	8-81 yr
M:F (ratio)	7:18
TBSA (%)	0%-95% (all patients except one had > 30% of skin involvement)
Time of appearance of GI symptoms	0 wk-7 wk (usually within two weeks) after appearance of rash/mucosal lesions
Chief symptoms	GI bleeding-17 (68%) Diarrhoea-13 (52%) Abdominal pain-10 (40%) Abdominal distension-3 (12%) Vomiting-2 (8%)
Complications/ Extent of GI involvement	Luminal erosions/inflammation-15 (60%) Ulcer (Single or multiple)-9 (36%) [Large bowel (6). Small bowel (3), Esophageal (3), Gastric (2)] Perforation-3 (12%) (small bowel/colon) Strictures-2 (8%) (ileal/ileo-colonic) Mesentric ischaemia/ Intestinal infarction/ Ileoileal intussusceptions,/ Pseudodiverticular sacs/ Intraabdominal abscess,/ Pseudomembranes formation/ Subacute intestinal obstruction-One each Malabsorption/ Hypoalbumenia/ Protein-losing enteropathy- One each
Treatment	Medical [Steroids (14), IVig (4), TPN (4), Probiotics (2), PP (1), PE (1), EN (1)] Surgery-8 (32%)
Outcome	Survived- 14 (56%) [LOS (range)- 10 d -9 mo, DOI (range)-1-6 mo] Expired-11 (44%)

TBSA: Total body surface area; GI: Gastrointestinal; M: Male; F: Female; TPN: Total parenteral nutrition; LOS: Length of stay; IVIg: Intravenous immunoglobulin; PE: Plasma exchange; EN: Enteral nutrition; DOI: Duration of illness.