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Collagenous sprue cross-sectional imaging: a comparative blinded study

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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Collagenous sprue (CS) is a rare enteropathy characterized by villous atrophy and a thickened subepithelial collagen band. The aim of this study is to describe the cross-sectional imaging findings of CS.

Methods

A case–control, retrospective study with cases of all CS patients from January 2000 to 2015 was performed. Inclusion criteria were (1) Histopathologic diagnosis and (2) Imaging with computed tomography abdomen/pelvis (CT A/P), CT enterography (CTE), or magnetic resonance enterography within 6 months of small bowel (SB) biopsy. Control subjects were irritable bowel syndrome (IBS) patients who underwent CTE. Imaging studies were examined by two GI radiologists, blinded to patient data.

Results

108 patients (54 CS; 54 IBS) were included. Mean age was 56.7 ± 16.5 years, and 68% were female (72% in CS group vs. 63% in IBS group; p = 0.3). CS patients were significantly older (67 ± 12 vs. 47 ± 15 year; p < 0.001) and more likely to be on angiotensin receptor blockers (41% vs. 6%; p < 0.001) as compared to the IBS group. Compared to IBS, CS patients were more likely to have mesenteric lymph node (LN) prominence (56% vs. 15%; p < 0.001), jejunoileal fold pattern reversal (46% vs. 6%; p < 0.001), SB dilation (28% vs. 0%; p < 0.001), SB conformational change (28% vs. 6%; p = 0.002), SB wall thickening (13% vs. 2%; p = 0.03), and ulcerative jejunoileitis (4% vs. 0%; p = 0.01). Radiologists suspected malabsorption in 72% in the CS group and 2% in the IBS group (p < 0.001).

Conclusion

Imaging findings suggestive of mucosal malabsorption are commonly demonstrated in CS.

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Abbreviations

CS:

Collagenous sprue

SB:

Small bowel

CTE:

Computed tomography enterography

MRE:

Magnetic resonance enterography

CT A/P:

Computed tomography abdomen/pelvis

MRI:

Magnetic resonance imaging

SMV:

Superior mesenteric vein

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Author contributions

BA-B, Study design, data abstraction, analysis, manuscript draft and revision. SPS, Study design, review of radiographic images, manuscript review and editing. MBH, Manuscript draft and revision. JAM Manuscript draft, review and editing. AR-T, Manuscript review and editing. ER, Manuscript review and editing. DHB, Study design, manuscript review and editing. SLH, Study design, manuscript review and editing. JMB, Manuscript review and editing. JGF, Original concept, study design, manuscript review and editing. JLF, Original concept, study design, review of radiographic images, manuscript review and editing.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA

    Badr Al-Bawardy, Joseph A. Murray, Alberto Rubio-Tapia, Elizabeth Rajan, David H. Bruining & Stephanie L. Hansel

  2. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Shannon P. Sheedy, John M. Barlow, Joel G. Fletcher & Jeff L. Fidler

  3. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Michelle B. Herberts

Authors
  1. Badr Al-Bawardy
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  2. Shannon P. Sheedy
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  3. Michelle B. Herberts
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  4. Joseph A. Murray
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  5. Alberto Rubio-Tapia
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  6. Elizabeth Rajan
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  7. David H. Bruining
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  8. Stephanie L. Hansel
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  9. John M. Barlow
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  10. Joel G. Fletcher
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  11. Jeff L. Fidler
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Corresponding author

Correspondence to Badr Al-Bawardy.

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Funding

No funding was received for this study.

Conflict of interest

Joseph A Murray: grant support from the National Institutes of Health (money paid to institution) and Alba Therapeutics (money paid to institution); Oberkotter Foundation (Oberkotter #1) (money paid to institution) and Broad Medical Research Program at CCFA (CCFA 342367) (money paid to institution); advisory boards Celimmune, LLC (money paid to JAM); AMAG Pharmaceuticals (money paid to JAM), Entera Health, Inc (money paid to JAM), Sonomaceuticals, LLC (money paid to JAM), BioLineRx (money paid to JAM), GlaxoSmithKline (GSK) (money paid to JAM), Genentech (money paid to JAM), Glenmark Pharmaceuticals Ltd (money paid to JAM); consultant to Boehringer Ingelheim (money paid to JAM); holds equity options in Torax (money paid to JAM and institution). The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by our institutional IRB prior to initiation. As this was a retrospective study, participating patients had consented to the retrospective use of images and other medical data for research purposes.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.

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Al-Bawardy, B., Sheedy, S.P., Herberts, M.B. et al. Collagenous sprue cross-sectional imaging: a comparative blinded study. Abdom Radiol 42, 396–402 (2017). https://doi.org/10.1007/s00261-016-1007-1

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  • DOI: https://doi.org/10.1007/s00261-016-1007-1

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