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Crohn’s disease: prevalence of intestinal and extraintestinal manifestations detected by computed tomography enterography with water enema

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Abstract

Background

Computed tomography enterography (CTE) may detect the presence, severity, and extent of bowel inflammation in patients with Crohn’s disease (CD). The aim of our study was to assess, among a cohort of 22 histologically proven CD patients, the prevalence of disease distribution, behavior, anastomotic recurrence and extraintestinal manifestations detected by an original CTE technique.

Methods

Two radiologists reviewed 221 CTEs performed providing both small and large bowel distension by oral administration of neutral contrast material and trans-rectal introduction of a water enema (CTE-WE).

Results

Ileal CD was detected in 116 CTE-WEs (52.4%), including 71/116 (61.2%) non-stricturing/non-penetrating, 17/116 (14.6%) stricturing, and 28/116 (24.1%) penetrating forms. Colonic CD was appreciable in 35 (15.8%) patients, including 18/35 (51.4%) non-stricturing/non-penetrating, 6/35 (17.1%) stricturing, and 11/35 (31.4%) penetrating forms. Ileocolic CD was present in 52 (23.5%) CTE-WEs, including 30/52 (57.7%) non-stricturing/ non-penetrating; 3/52 (5.7%) stricturing, and 19/52 (36.5%) penetrating forms. In 10/221 patients (4.5%), upper gastrointestinal involvement (UGI) was present. Perianal disease was observed in 17/221 patients (7.7%). Fistulas were present in 52 (23.5%) and abscesses in 24 (10.8%) CTE-WEs, respectively. Among 57/221 (25.8%) patients who had undergone a disease-related intestinal resection, in 30/57 cases (52.6%) CD recurrence at the anastomosis was present. 4/221 patients (1.8%) with a histologically confirmed intestinal neoplastic stenosis were observed. Sacroiliitis (24%) was found to be prevalent over hepatic steatosis (10.8%), cholelithiasis (8.6%), and nephrolithiasis (4%).

Conclusions

CTE-WE represents a comprehensive imaging technique which may demonstrate bowel inflammation and CD extraintestinal manifestations. A peculiar prevalence of UGI involvement and neoplastic strictures were observed. In our study the prevalence of sacroiliitis resulted higher than previously reported.

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Abbreviations

IBD:

Inflammatory bowel disease

CT:

Computed tomography

CTE:

Computed tomography enterography

CTE-WE:

Computed tomography enterography with water enema

CD:

Crohn’s disease

GI:

Gastrointestinal

UGI:

Upper gastrointestinal

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Authors and Affiliations

  1. Department of Radiology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genova, Italy

    F. Paparo, L. Bacigalupo, E. Biscaldi & G. A. Rollandi

  2. School of Radiology, University of Genoa, Genova, Italy

    I. Garello

  3. Internal Medicine Department, Rheumatology Clinic, University of Genoa, Genova, Italy

    M. A. Cimmino

  4. Pathology Service, E.O. Ospedali Galliera, Genova, Italy

    E. Marinaro

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  1. F. Paparo
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Correspondence to F. Paparo.

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Paparo, F., Bacigalupo, L., Garello, I. et al. Crohn’s disease: prevalence of intestinal and extraintestinal manifestations detected by computed tomography enterography with water enema. Abdom Imaging 37, 326–337 (2012). https://doi.org/10.1007/s00261-011-9832-8

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