Nodular lymphoid hyperplasia: A marker of low-grade inflammation in irritable bowel syndrome?

Abstract

AIMTo evaluate the prevalence of nodular lymphoid hyperplasia (NLH) in adult patients undergoing colonoscopy and its association with known diseases.METHODSWe selected all cases showing NLH at colonoscopy in a three-year timeframe, and stratified them into symptomatic patients with irritable bowel syndrome (IBS)-type symptoms or suspected inflammatory bowel disease (IBD), and asymptomatic individuals undergoing endoscopy for colorectal cancer screening. Data collection included medical history and final diagnosis. As controls, we considered all colonoscopies performed for the aforementioned indications during the same period.RESULTSOne thousand and one hundred fifty colonoscopies were selected. NLH was rare in asymptomatic individuals (only 3%), while it was significantly more prevalent in symptomatic cases (32%). Among organic conditions associated with NLH, the most frequent was IBD, followed by infections and diverticular disease. Interestingly, 31% of IBS patients presented diffuse colonic NLH. NLH cases shared some distinctive clinical features among IBS patients: they were younger, more often female, and had a higher frequency of abdominal pain, bloating, diarrhoea, unspecific inflammation, self-reported lactose intolerance and metal contact dermatitis.CONCLUSIONAbout 1/3 of patients with IBS-type symptoms or suspected IBD presented diffuse colonic NLH, which could be a marker of low-grade inflammation in a conspicuous subset of IBS patients.

Ileocolonic Lymphonodular Hyperplasia in Children Related to Etiologies Ranging from Food Hypersensitivity to Familial Mediterranean Fever

“…“Minimal lesion colitis,” also called colonic LNH is a common feature of IBS, IBD, Ni-allergy syndrome and other conditions such as hypersensitivity reactions, immunodeficiency, and chronic gastrointestinal infections. The factors and pathogenesis involved in the development of different clinical features from the same pathology are still under evaluation [25].…”

Functional gastrointestinal disorders in women with systemic lupus erythematosus: A case‐control study

“…In some reports, autoimmune and autoinflammatory diseases such as Henoch‐Schönlein purpura in children and rheumatoid arthritis and familial Mediterranean fever in adults have been linked to an increased risk of FGIDs . Because those conditions including SLE have an underlying inflammatory mechanism and FGIDs have been associated with low‐grade inflammation of the digestive tract mucosa and a state of immune activation, there could be a common pathophysiological process explaining these comorbidities. Future studies should evaluate the prevalence of FGIDs in SLE patients not receiving glucocorticoids or NSAIDs.…”

Case Report: Intestinal Nodular Lymphoid Hyperplasia as First Manifestation of Activated PI3Kδ Syndrome Due to a Novel PIK3CD Variant

“…NLH has been observed at any age, but it has most frequently been reported during childhood (4). Clinical manifestations include diarrhea, malabsorption, gastrointestinal bleeding, and abdominal pain, but many affected patients may be asymptomatic, and NLH can be an incidental finding (5,6). Despite NLH being a non-clonal benign lesion, its presence has been reported as a risk factor for intestinal lymphoma (4).…”