Mesenteric border linear ulcer in Crohn disease: historical, radiologic, and pathologic perspectives

Herlinger, Hans; Rubesin, Stephen E.; Furth, Emma E.

doi:10.1007/s002619900302

Cited by 18 publications

(3 citation statements)

References 11 publications

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“…57.28). Deep linear ulcers typically are present along the mesenteric surface of the mucosa and contract the lumen in an asymmetrical pattern [257]. Linear ulcerations surrounding "islands" of normal mucosa produce a "cobblestone" appearance whereas parallel deep linear ulcerations can produce a "bear-clawed" appearance ( Fig.…”

Section: Histologymentioning

confidence: 99%

Inflammatory Bowel Disease

Stenson

Hanauer

Cohen

2008

Textbook of Gastroenterology

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In the US, H. pylori vacA shows allelic variation in the signal sequence (which may be type sla, slb or s2) and the mid-region (type ml or m2). Previous PCR-based vacA mid-region typing classified most, but not all, Asian and South American strains tested as ml or m2. We now sought to investigate vacA mid-region diversity further.MotlmodL We studied 13 Japanese, 6 Chinese, 9 Thai, and 8 Peruvian H. pylori isolates. cagA was identified by colony hybridisation (CH), vacA signal sequence was typed by PCR, and vacA mid-region was typed proximally by CH and distally by PCR. Sections of the vacA mid-region from 8 strains were PCR-amplified, sequenced, and compared with known sequences from 8 other strains.Rcuts Of the 36 Asian and South American strains studied, 35 were cagA+ (the cagA-was Peruvian) and 35 were vacA sla (1 cagA + Peruvian was slb). vacA mid-regions from the 13 Japanese strains were not PCR-amplified by ml or m2-specific primers, but hybridised weakly with an ml probe. Sequence analysis of vacA from 1 Japanese strain revealed 91% nucleotide identity with the ml probe but only 71% identity with the m2 probe. The previously equivocal Thai and Peruvian strains also had ml-like mid-region sequences. A Chinese strain was ml in the proximal mid-region and m2 distally, showing a clear crossover site. Final mid-region types were: Japanese, all 13 ml; Chinese, 1 ml, 1 ml/m2, 4 m2; Thai, 3 ml, 6 m2; Peruvian 4 ml, 4 m2. Distal mid-region sequences of 16 strains, compared over 294 bp, clustered into 2 groups, ml and m2. Nucleotide identity between ml and m2 strains ranged from 73-78%. Within groups, m2 strains were less diverse than ml strains (m2 range 94-99.7%, ml 88-99.3%, p<0.001). Sequence analysis of 7 ml and 3 m2 strains over 1.1kb proximally showed maintenance of clustering outside the 294bp region C duions These Asian and South American strains are similar in terms of cagA status and vacA sla genotype, but fall into 2 vacA midregion groups. ml sequences are more diverse than m2, and thus may be phylogenetically older. The vacA sequence of 1 Chinese strain suggests recombination in vivo between ml and m2 alleles. Introduction: H.pylori antimicrobial susceptibility is an important determinant ofthe efficacy of eradication therapies'. The prevalence of antimicrobial resistance varies within the UK and may increase given the increased use of eradication therapy. This multicentre study assesses the prevalence and possible associations ofH.pylon antimicrobial resistance. Methods: H.pylon was isolated from antral biopsies of patients undergoing routine endoscopy and cultured according to standard microbiological methods. Antimicrobial resistance was determined using "E-tests" or disc tests (tinidazole only) with breakpoints defined by previous studies. Results: H.pyloni was isolated from 32% (1222/3823) of patients and antimicrobial susceptibility determined in 90% (1077/1222) Previous case-control studies of IBD have used hospital or community derived controls. There are obvious inherent biases in both metho...

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Section: Histologymentioning

confidence: 99%

Inflammatory Bowel Disease

Stenson

Hanauer

Cohen

2008

Textbook of Gastroenterology

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“…Crohn disease.-Crohn disease has a marked predilection for the terminal ileum because of the high concentration of lymphoid tissue in the distal ileum; however, additional "skip" lesions can be seen more proximally in the small bowel, and sparing of the terminal ileum occurs in about 1% of patients. Characteristic findings on barium studies include aphthoid ulcers (Fig 21), larger ulcers, linear mesenteric border ulcers, antimesenteric border sacculations, focally thickened irregular folds, an ulceronodular pattern ("cobblestoning") ( Fig 22), marked ileal narrowing with a "string" sign due to a combination of severe edema and spasm or fibrosis (Fig 23), and separation of ileal loops by fibrofatty proliferation in the mesentery (31,(34)(35)(36)(37). Complications of Crohn disease include fistulas (especially ileoileal, ileocecal, and ileosigmoid fistulas) (Fig 24), abscesses, perforation, obstruction, and, in patients with longstanding disease, an increased risk of developing small-bowel carcinoma or lymphoma.…”

Section: Irregular-segmental Thickeningmentioning

confidence: 99%

Pattern Approach for Diseases of Mesenteric Small Bowel on Barium Studies

Levine¹,

Rubesin²,

Laufer³

2008

Radiology

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Despite an array of sophisticated imaging techniques, the barium examination remains a valuable diagnostic test for evaluating structural abnormalities of the small bowel. Most patients can be examined with conventional small-bowel follow-through studies, in which periodic imaging of the entire small bowel is performed by using fluoroscopic guidance; however, some patients may benefit from enteroclysis, in which contrast agents are instilled into the small bowel via a catheter placed in the proximal jejunum for optimal distention and better depiction of individual small-bowel loops. This review for residents discusses the major diseases involving the mesenteric small bowel and presents a pattern approach for the wide spectrum of abnormalities found on barium studies, including polypoid lesions, cavitated lesions, annular lesions, outpouchings, separation of loops, abnormal folds, nodules without abnormal folds, and dilated small bowel.

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“…The radiographic findings of Crohn's disease vary from the earliest changes of lymphoid hyperplasia, aphthoid lesion, and fold thickening to the more advanced changes of deep linear and transverse ulcerations that create the classic cobblestoning pattern in the mucosa and finally to the development of strictures and fistulas [22][23][24]. In our side-by-side analysis of the CT scans and barium enema studies, we found that the main differences in the radiographic findings for the small bowel and colon between the group with prominent pericolic or perienteric vasculature and the group without this type of vasculature were the common occurrence of longitudinal and perpendicular ulceration (cobblestone mucosa) and the extensive length of involvement of the small bowel or colon in patients with the CT finding of prominent vasculature.…”

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confidence: 99%