The serious gastrointestinal complications in collagen or connective-tissue diseases include perforation, hemorrhage, and infarction, occurring separately or in combination. Peritonitis, intraperitoneal abscesses, fistulae, stenosis of the intestine, and intestinal obstruction may follow. Although the process may occur at any clinical stage of the disease, and on occasion may be the presenting symptom, most often the complications occur late in the clinical course or in the terminal stages.
The role of steroid therapy in the pathogenesis of the gastrointestinal lesions is difficult to assess. Since the lesions do occur in the absence of steroid administration, it appears likely that they result primarily from vascular changes produced by the underlying disease. However, steroid therapy may also be a complicating factor in their origin, healing, and clinical recognition.
In a recent study, reported in the October issue of the Archives of Surgery1, one or more of the gastrointestinal complications developed in 20%