Bowel ultrsonography in detecting bowel stenosis in inflammatory bowel diseases

Bowel ultrsonography in detecting bowel stenosis in inflammatory bowel diseases


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BOWEL ULTRSONOGRAPHY lN DETECTING BOWEL STENOSIS IN INFLAMMATORY BOWEL DISEASES wc N, Grbovic A, Kovacevic N, Djuranovic S, Ugljesic M, Milosavljevic T, Popovic D, Dugalic P, Krstic M, Bulajic M Institute for digestive diseases, University of Belgrade Medical School, Belgrade, Yugoslavia Background and aim: High-resolution bowel ultrasonography (BUS) has proved its value in the assessment of the complications of inflammatory bowel diseases (IBD), such as fistulas and abscesses. We investigated its accuracy in detection of stenosis in regards to endoscopy and barium enema studies. Patients and methods: Seventy two patients with patohistologic diagnosis of Crohn’s disease [CD) and ulcerative colitis (UC) underwent colonoscopy with ileoscopy, irigography and enteroclysis and BUS during the same hospitalization. BUS was performed with 3.5 and 7.5 MHz probes, by trained examinator who knew the diagnosis, but was not informed about the complications. relative stenosis was defined as partial segment narrowing of the bowel with or without minimal prestenotic dilatation. Absolute stenosis was defined by the cchopattern of extremely narrowed bowel lumen with or without trapped air in the lumen and with poststenotic dilatation. Results: Sensitivity, specificity, positive and negative predictive values for the relative stenosis in IBD by BUS were 93.0%, 92.0%, 75.0% and 98.0% respectively. The a.une parameters for absolute stenosis were as follows: 96.0%, 97.0%, 92.C’h and 98.0% respectively. Conclusion: BUS is very useful as a starting procedure for detecting strictures in IBD; ,h\ an orientation method for further endoscopy or X-ray procedures.

M, Jesic R Institute for digestive diseases, University of Belgrade Medical School. Belgrade, Yugoslavia Background: Activity index (AI) of Crohn’s disease (CD) is determined on the basis of clinical, endoscopy and histology activity index and laboratory values (C reactive protein, fibrinogen, albumins, hemoglobin, SER, leukocyte and trombocyte count). Patohistological finding represents the final diagnosis. Best’s Crohn’s disease activity index (CDAI) is used for clinical follow up.

Aims: To evaluaterelationshipbetweenclinical, endoscopyand histology activity index in patientswith complicated Crohn’s disease. Patients and methods: We included 30 patients with complicated Crohn’s

disease. Complicationsincludedpulmonarytuberculosis,steatosishepatis, primary sclerosingcholangitis,cholelithiasis,nephrolithiasis,myocarditis, disseminated intravascular coagulation, fish&s, derrnatological and rheumatologicdisorders.We statisticallycorrelatedclinical with endoscopy and histologyAI. Results: There were highly statistical correlation (pcO.01) between clinical and endoscopy AI (Pearson’s R=0.482; Spearman’s R=0.530). At the same time we predictedby 95% confidencethat patientswith CDAI betweenI22 and 150 will have 1 degree of endoscopic AI, with CDAl from 202 to 264 - II and between 264 and 386 - III endoscopic activity degree respectively. We found statistically correlation between CDAI and histological Al (piO.05) Since Pearson’s (R=0.322) and Spearman’s (R=0.448) coefficients were low, it wasn’t possible to establish the numerical correlation between the value of CDAI and the histological AI. Correlation between histological

and endoscopy IA was significant (p

THE USE OF MAGNETIC RESONANCE IMAGING AND TRANSABDOMINAL BOWEL SONOGRAPHY IN DETECTING FISTULAS IN CROHNS DISEASE !&&&novic S, Grbovic A, Lilic G, Kovacevic N, Krstic R, Cabric 1, Mijalkovic N, Popovic D, Dugalic P, Bulajic M, Zdravkovic D Institute for digestive diseases, University of Belgrade Medical School, Belgrade, Yugoslavia Background: Magnetic resonance imaging (MRI) has proven the best accuracy in detecting intraabdominal and p&anal fistulas in Crohn’s disease (CD) with very high specificity and sensitivity. As non-expensive, easily repetitive, non-invasive transabdominal bowel sonography (TABS) and perianal sonography (PAS) is nowdays under investigation as a diagnostic tool for detecting the complications of CD. Aims: To validate the accuracy of TABS in CD fistulas in regards to MRI tindings. Patients and methods: Thirty eight patients (pts) with histologically proven diagnosis of CD underwent gray-scale TABS with 3.5 and 7.5 MHz probes followed by MRI during the same hospitalization. MRI was performed with 1.5 Tesla superconductive magnet (Siemens). We used oral (Lumirem) and intravenous (Gadolinium) contrast and the images were presented on axial and coronal planes. PAS was routinely added for perianal evaluation. We compared TABS and PAS with MRI findings. Results: TABS correctly detected I8 out of 24 fistulas (75.0%) of different location (313 ileocutane, l/l ileoscrotale, 113 ileosygmoid. l/1 ileovesical, 3i6 enteroenteric, -114 colocolic, 415 ileoretroperitoneal and l/l rectovaginal tistulas). TABS couldn’t visualize any of 8 existing perianal tistulas, but PAS revealed 6 of them (75.0%). In all tistulas, except ileosygmoid and rectovaginal, the recognition was relatively easy by TABS. Conclusion: TABS is very useful in detecting and especially in follow up of CD fistulas, especially because of low cost ofthis method


KINETICS OF ASCA: A TIME-RELATED STUDY IN A BELGIAN CD POPULATION. Joossens S, Vermeire S, Peeters M, Bossuyt X’ and Rutgeerts P. Dpt of Gastroenterology and Immunology’, UZ Leuven, Belgium. Introduction & Aims: ASCA (Anti Saccharomyces cerevisiae antibodies) has been associated with Crohn’s disease (CD). The exact origin of these antibodies is however unclear. The fact that they occur in a subset of unaffected relatives but not in healthy spouses is pointing towards genetic factors or early childhood exposure. ASCA could therefore represent a marker reflecting susceptibility for CD. As a consequence, one would expect ASCA not to fluctuate during disease course. No studies are available on the kinetics of this serological marker. Methods: Serum was obtained from 81 CD patients and ASCA was determined at 2 different times (mean time interval: 16.9 months, range 1-36 months), using a standardized ELISA. The ASCA assay was obtained from Dr D Poulain (Lille, France). As a control group, 24 UC patients were used (mean time interval: 19 months, range 3-34 months). Results: At tt, 58% (47/S]) CD patients were ASCA+ (p