小儿隐源性多灶性溃疡性狭窄肠炎与小肠克罗恩病和胃肠结核的鉴别:回顾性研究(附视频)。

IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY
Indian Journal of Gastroenterology Pub Date : 2024-12-01 Epub Date: 2024-06-21 DOI:10.1007/s12664-024-01604-3
Arghya Samanta, Moinak Sen Sarma, Sumit Kumar Singh, Anshu Srivastava, Ujjal Poddar, Ankur Mandelia, Vinita Agrawal, Surendra Kumar Yachha, Richa Lal
{"title":"小儿隐源性多灶性溃疡性狭窄肠炎与小肠克罗恩病和胃肠结核的鉴别:回顾性研究(附视频)。","authors":"Arghya Samanta, Moinak Sen Sarma, Sumit Kumar Singh, Anshu Srivastava, Ujjal Poddar, Ankur Mandelia, Vinita Agrawal, Surendra Kumar Yachha, Richa Lal","doi":"10.1007/s12664-024-01604-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare entity that mimics various inflammatory strictures of the small intestine. Pediatric literature is scarce. We analyzed the clinical, radiological, endoscopic and histopathological features of children with CMUSE that differentiate it from small bowel Crohn's disease (SBCD) and gastrointestinal tuberculosis (GITB).</p><p><strong>Methods: </strong>CMUSE was diagnosed by the following criteria: (1) unexplained small bowel strictures with superficial ulcers, (2) chronic/relapsing ulcers of small bowel after resection, (3) no signs of systemic inflammation, (4) absence of other known etiologies of small bowel ulcers. SBCD and GITB were diagnosed based on standard criteria. The clinical features, laboratory parameters, radioimaging, endoscopy (including video capsule endoscopy [VCE], intra-operative endoscopy), histopathological features and treatment outcome were noted.</p><p><strong>Results: </strong>Out of 48, CMUSE was diagnosed in 13 (27%) isolated small bowel and ileocecal strictures, while GITB and SBCD accounted for 41% and 21% cases, respectively. Common presentations were sub-acute obstruction (46%), obscure gastrointestinal bleeding (38%) and protein-losing enteropathy (38%). CMUSE patients had significantly longer disease duration compared to SBCD and GITB (p < 0.001). SBCD (90.0%) and GITB (85%) cases had elevated C-reactive protein (CRP), none with CMUSE had elevated CRP (p < 0.001). The disease was localized in jejunum (100%) and proximal ileum (56%) in CMUSE, ileocecal region (85%) in GITB, but evenly distributed in small intestine in SBCD. Endoscopy showed evenly placed, superficial, circumferential ulcers with strictures in CMUSE, deep linear ulcers in SBCD and circumferential ulcers in GITB. Upfront immunosuppression was given in four; three (75%) of them relapsed. Only surgery was done in three with one (25%) having relapse. Upfront surgery followed by immunosuppression was used in six, but all relapsed and two required repeat surgery.</p><p><strong>Conclusion: </strong>CMUSE is important but underdiagnosed in children. Lack of constitutional symptoms, normal inflammatory parameters and characteristic ulcers with strictures helped in differentiating CMUSE from GITB and SBCD.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Discrimination of pediatric cryptogenic multifocal ulcerous stenosing enteritis from small bowel Crohn's disease and gastrointestinal tuberculosis: A retrospective study (with videos).\",\"authors\":\"Arghya Samanta, Moinak Sen Sarma, Sumit Kumar Singh, Anshu Srivastava, Ujjal Poddar, Ankur Mandelia, Vinita Agrawal, Surendra Kumar Yachha, Richa Lal\",\"doi\":\"10.1007/s12664-024-01604-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare entity that mimics various inflammatory strictures of the small intestine. Pediatric literature is scarce. We analyzed the clinical, radiological, endoscopic and histopathological features of children with CMUSE that differentiate it from small bowel Crohn's disease (SBCD) and gastrointestinal tuberculosis (GITB).</p><p><strong>Methods: </strong>CMUSE was diagnosed by the following criteria: (1) unexplained small bowel strictures with superficial ulcers, (2) chronic/relapsing ulcers of small bowel after resection, (3) no signs of systemic inflammation, (4) absence of other known etiologies of small bowel ulcers. SBCD and GITB were diagnosed based on standard criteria. The clinical features, laboratory parameters, radioimaging, endoscopy (including video capsule endoscopy [VCE], intra-operative endoscopy), histopathological features and treatment outcome were noted.</p><p><strong>Results: </strong>Out of 48, CMUSE was diagnosed in 13 (27%) isolated small bowel and ileocecal strictures, while GITB and SBCD accounted for 41% and 21% cases, respectively. Common presentations were sub-acute obstruction (46%), obscure gastrointestinal bleeding (38%) and protein-losing enteropathy (38%). CMUSE patients had significantly longer disease duration compared to SBCD and GITB (p < 0.001). SBCD (90.0%) and GITB (85%) cases had elevated C-reactive protein (CRP), none with CMUSE had elevated CRP (p < 0.001). The disease was localized in jejunum (100%) and proximal ileum (56%) in CMUSE, ileocecal region (85%) in GITB, but evenly distributed in small intestine in SBCD. Endoscopy showed evenly placed, superficial, circumferential ulcers with strictures in CMUSE, deep linear ulcers in SBCD and circumferential ulcers in GITB. Upfront immunosuppression was given in four; three (75%) of them relapsed. Only surgery was done in three with one (25%) having relapse. Upfront surgery followed by immunosuppression was used in six, but all relapsed and two required repeat surgery.</p><p><strong>Conclusion: </strong>CMUSE is important but underdiagnosed in children. Lack of constitutional symptoms, normal inflammatory parameters and characteristic ulcers with strictures helped in differentiating CMUSE from GITB and SBCD.</p>\",\"PeriodicalId\":13404,\"journal\":{\"name\":\"Indian Journal of Gastroenterology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Indian Journal of Gastroenterology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s12664-024-01604-3\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12664-024-01604-3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/21 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

简介隐源性多灶性溃疡性狭窄肠炎(CMUSE)是一种罕见的疾病,它模仿各种小肠炎症性狭窄。儿科文献很少。我们分析了 CMUSE 患儿的临床、放射学、内窥镜和组织病理学特征,以将其与小肠克罗恩病(SBCD)和胃肠结核(GITB)区分开来:CMUSE 的诊断标准如下:(方法:CMUSE 的诊断标准如下:(1)原因不明的小肠狭窄并伴有浅表溃疡;(2)小肠切除术后出现慢性/复发性溃疡;(3)无全身炎症迹象;(4)无其他已知的小肠溃疡病因。SBCD 和 GITB 的诊断依据标准。临床特征、实验室参数、放射影像学检查、内窥镜检查(包括视频胶囊内窥镜检查 [VCE]、术中内窥镜检查)、组织病理学特征和治疗结果均被记录在案:在 48 例病例中,13 例(27%)被诊断为孤立性小肠和回盲肠狭窄,而 GITB 和 SBCD 分别占 41% 和 21%。常见表现为亚急性梗阻(46%)、不明显的消化道出血(38%)和蛋白丢失性肠病(38%)。与 SBCD 和 GITB 相比,CMUSE 患者的病程明显更长(P 结论:CMUSE 是一种重要的疾病,但却被低估了:CMUSE在儿童中很重要,但诊断不足。缺乏体征、正常的炎症指标和带有狭窄的特征性溃疡有助于将 CMUSE 与 GITB 和 SBCD 区分开来。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Discrimination of pediatric cryptogenic multifocal ulcerous stenosing enteritis from small bowel Crohn's disease and gastrointestinal tuberculosis: A retrospective study (with videos).

Introduction: Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare entity that mimics various inflammatory strictures of the small intestine. Pediatric literature is scarce. We analyzed the clinical, radiological, endoscopic and histopathological features of children with CMUSE that differentiate it from small bowel Crohn's disease (SBCD) and gastrointestinal tuberculosis (GITB).

Methods: CMUSE was diagnosed by the following criteria: (1) unexplained small bowel strictures with superficial ulcers, (2) chronic/relapsing ulcers of small bowel after resection, (3) no signs of systemic inflammation, (4) absence of other known etiologies of small bowel ulcers. SBCD and GITB were diagnosed based on standard criteria. The clinical features, laboratory parameters, radioimaging, endoscopy (including video capsule endoscopy [VCE], intra-operative endoscopy), histopathological features and treatment outcome were noted.

Results: Out of 48, CMUSE was diagnosed in 13 (27%) isolated small bowel and ileocecal strictures, while GITB and SBCD accounted for 41% and 21% cases, respectively. Common presentations were sub-acute obstruction (46%), obscure gastrointestinal bleeding (38%) and protein-losing enteropathy (38%). CMUSE patients had significantly longer disease duration compared to SBCD and GITB (p < 0.001). SBCD (90.0%) and GITB (85%) cases had elevated C-reactive protein (CRP), none with CMUSE had elevated CRP (p < 0.001). The disease was localized in jejunum (100%) and proximal ileum (56%) in CMUSE, ileocecal region (85%) in GITB, but evenly distributed in small intestine in SBCD. Endoscopy showed evenly placed, superficial, circumferential ulcers with strictures in CMUSE, deep linear ulcers in SBCD and circumferential ulcers in GITB. Upfront immunosuppression was given in four; three (75%) of them relapsed. Only surgery was done in three with one (25%) having relapse. Upfront surgery followed by immunosuppression was used in six, but all relapsed and two required repeat surgery.

Conclusion: CMUSE is important but underdiagnosed in children. Lack of constitutional symptoms, normal inflammatory parameters and characteristic ulcers with strictures helped in differentiating CMUSE from GITB and SBCD.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Indian Journal of Gastroenterology
Indian Journal of Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
3.90
自引率
10.00%
发文量
73
期刊介绍: The Indian Journal of Gastroenterology aims to help doctors everywhere practise better medicine and to influence the debate on gastroenterology. To achieve these aims, we publish original scientific studies, state-of -the-art special articles, reports and papers commenting on the clinical, scientific and public health factors affecting aspects of gastroenterology. We shall be delighted to receive articles for publication in all of these categories and letters commenting on the contents of the Journal or on issues of interest to our readers.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信