Small bowel stenosis in Crohn's disease: clinical, biochemical and ultrasonographic evaluation of histological features

Abstract

Summary Aim : To establish whether intestinal ultrasound, clinical or biochemical indices of activity can assess histological features of ileal stenosis in Crohn's disease. Methods : In 43 patients undergoing surgery for a single ileal stenosis, clinical and biochemical parameters, as well as intestinal ultrasound, were assessed prior to surgery. The echo pattern of thickened bowel segments at the site of stenosis was classified as hypoechoic, stratified or mixed (segments with/without stratification). During surgery, stenoses were identified, resected and then histologically examined using standardized criteria. Results : Clinical and biochemical indices of activity showed an overall weak positive correlation with histological inflammatory parameters and a negative correlation with fibrosis. The intestinal ultrasound echo pattern at the stenosis site was stratified in 25 patients, hypoechoic in 14 and mixed in four. Stenoses characterized by a stratified echo pattern showed a significantly higher degree of fibrosis, those characterized by hypoechoic echo pattern showed a higher degree of inflammation, while stenoses with a mixed echo pattern showed high degrees of both fibrosis and inflammation. Conclusion : Ultrasound and, to a lesser degree, clinical and laboratory indices discriminate between inflammatory and fibrotic ileal stenoses complicating Crohn's disease, thus allowing appropriate medical and/or surgical treatment to be defined.

SICUS and CEUS imaging in Crohn’s disease: an update

“…Within the last two decades, among the cross-sectional imaging techniques, the US has had a growing role in the development and application of techniques for the diagnosis of gastrointestinal diseases, such as appendicitis, diverticulitis and inflammatory bowel diseases (IBD) [12]. Today, bowel US is currently accepted as a clinically important first-line imaging technique in both patients with suspected CD and in follow-up patients known to have CD [13][14][15][16][17][18][19]. Furthermore, the introduction of oral contrast has improved the image quality, overall sensitivity and diagnostic accuracy in the detection of small bowel lesions in CD patients [20], and thus contrast-enhanced ultrasound (CEUS) has become an important imaging modality in patients with CD for grading of disease activity, differentiation between small bowel stricture due to inflammation or mural fibrosis, and the assessment of the response to specific therapy [21,22].…”

Ultrasonographic findings in Crohn’s disease

“…Abdominal complications and extraintestinal features US also allows the identification of extraintestinal features that may be associated with active CD, such as mesenteric fat hypertrophy, the presence of regional enlarged lymph nodes and intraperitoneal free fluid accumulation [32,33]. Since US can find both intraluminal and extraintestinal pathological features, it is a valuable tool for the detection of complications such as stenosis, fistulas and abscesses.…”

“…9) or between intestinal loops and other structures, commonly subdivided into perineal, external and internal [33,36,37].…”

Transabdominal ultrasonografi ved inflammatorisk tarmsykdom

“…Den fortykkede tarmveggen i stenosen har liten eller ingen motilitet. Bortfall av lagdeling i stenosen indikerer ødem i tarmveggen og sannsynlig akutt inflammasjon, mens mer bevart lagdeling kan indikere fibrose (18). Det er viktig for valg av behandling å vite om den fortykkede veggen i en stenose skyldes hovedsakelig aktiv inflammasjon eller fibrose.…”