Isolated ileal erosions in patients with mildly altered bowel habits - A follow-up study of 28 patients
Isolated ileal erosions in patients with mildly altered bowel habits - A follow-up study of 28 patients
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DOI：
10.1309/4pk0g68m2g1l6x47
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发表时间：
2006-06-01
影响因子：
3.5
通讯作者：
Goldstein, Neal S.
中科院分区：
文献类型：
--
作者：
Goldstein, Neal S.
这项研究评估了28名患者，以表征与典型克罗恩病(CD)相关的形态特征。所有患者都有相似的主诉，内窥镜检查正常的结肠，回肠末端有小的孤立的口疮样糜烂。平均随访时间为5.8年。在28例患者中，25例(89%)为女性(平均年龄32.3岁)。四名患者正在服用非类固醇抗炎药。所有28个病灶在形态上都与局灶性固有层水肿、轻度活动性炎症和隐窝紊乱相似。多数在水肿区有淋巴集合体。21例组织学检查发现有糜烂。结肠镜检查后，所有28名患者的症状都消失了。平均间隔3.6年后，8名患者(29%)发展为典型的、完全发展的CD。CD病变在形态上与非CD病变相同。大多数有轻微排便习惯改变的患者的局灶性回肠糜烂是特发性的，临床意义不大。在大约30%的患者中，它们代表了早期CD。初步检查和典型CD之间的间隔可能很长。无论间隔多长时间，病理学家在检查回肠活检标本时，应保持诊断警惕。持续性的、轻微的形态异常很可能是CD。
This study evaluated 28 patients to characterize the morphologic features associated with typical Crohn disease (CD). All patients had similar complaints, an endoscopically normal colon, and small isolated, aphthoid erosions in the terminal ileum. The mean length of follow-up was 5.8 years. Of 28 patients, 25 (89%) were female (mean age, 32.3 years). Four patients were ingesting nonsteroidal anti-inflammatory drugs. All 28 lesions were morphologically similar with focal lamina propria edema, mild active inflammation, and crypt disarray. Most had a lymphoid aggregate within the region of edema. Erosion was identified histologically in 21 cases. Following colonoscopy, symptoms resolved in all 28 patients. Typical, full-blown CD developed in 8 patients (29%) after a mean interval of 3.6 years. CD lesions were morphologically identical to non-CD lesions. Most focal ileal erosions in patients with mildly altered bowel habits are idiopathic and clinically insignificant. They represent early CD in approximately 30% of patients. The interval between initial examination and typical CD can be long. Pathologists should remain diagnostically vigilant when examining ileal biopsy specimens obtained from patients with previous abnormal ileal biopsy findings, regardless of the interval. Persistent, mild morphologic abnormalities have a high likelihood of being CD.