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Abstract: Neutrophil to lymphocyte ratio has been examined among several studies regarding Henoch Schonlein purpura patients with gastrointestinal involvement. The current meta-analysis aims to evaluate neutrophil to lymphocyte ratio differences between Henoch Schonlein purpura patients with and without gastrointestinal manifestations.An extensive search of the available literature was done using MEDLINE (1966-2020), Clinicaltrials.gov (2008-2020), Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2020) and Google Scholar (2004-2020) databases and statistical analysis was mainly conducted using RevMan 5.3 software.The current meta-analysis is based on data from six studies. Neutrophil to lymphocyte ratio was higher in Henoch Schonlein patients with gastrointestinal involvement than those without with a mean difference of 0.88 (95% confidence interval [CI]: 0.55, 1.22 [P < 10-5, I2 = 8%]). Low heterogeneity (I2) was observed between the included studies. Subgroup analysis, leave one out meta-analysis and meta-regression analysis were performed which led to the lowering of I2 to 0.The findings of our meta-analysis suggest that the neutrophil to lymphocyte ratio could serve as a marker of gastrointestinal involvement in patients with Henoch Schonlein purpura; however, most of the included studies are case-control, therefore future cohort studies should clarify the value of this marker., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)