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Radmard AR, Amouei M, Torabi A, Sima AR, Saffar H, Geahchan A, Davarpanah AH, Taouli B. MR Enterography in Ulcerative Colitis: Beyond Endoscopy. Radiographics 2024; 44:e230131. [PMID: 38127661 DOI: 10.1148/rg.230131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disease (IBD) that progressively affects mucosa and submuccosa of the colon and rectum in a continual pattern. In comparison, Crohn disease (CD), the other type of IBD, is a chronic transmural inflammatory disorder that can involve any part of the gastrointestinal tract. MR enterography (MRE) has emerged as an important imaging modality for the diagnosis and detection of disease activity and complications in CD, with comparable results to those of endoscopy. But MRE has been underused for assessment of UC in recent years, and clinicians heavily rely on endoscopic findings for management of UC. Despite UC being considered an endoscopically assessable disease, MRE can provide useful information beyond that obtained with endoscopy about mural or extramural abnormalities, inaccessible parts of the colonic lumen, associated extraintestinal diseases, and superimposed pathologic conditions. Moreover, endoscopy might be contraindicated in some clinical settings due to the risk of colonic perforation. In addition to depicting the features of UC activity in different phases, MRE demonstrates findings of disease chronicity that cannot be achieved with endoscopy, particularly in a patient with colitis of unknown cause. The valuable diagnostic role of MRE to exclude undiagnosed CD in patients with UC who have refractory disease or those with postproctocolectomy complications is also emphasized. Radiologists can play a crucial role in the management of UC with MRE by addressing what is beyond endoscopy. ©RSNA, 2023 Test Your Knowledge questions are available in the supplemental material.
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Affiliation(s)
- Amir Reza Radmard
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Mehrnam Amouei
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Ala Torabi
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Ali Reza Sima
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Hiva Saffar
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Amine Geahchan
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Amir H Davarpanah
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Bachir Taouli
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
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Alkhiari R, Alharbi AM, Albadrani H, Alsaud JS, Alkhiari K. Obstructive Giant Inflammatory Polyp of the Colon in Ulcerative Colitis. Cureus 2023; 15:e45535. [PMID: 37868504 PMCID: PMC10585189 DOI: 10.7759/cureus.45535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Inflammatory polyps, also known as pseudo-polyps, are a common benign condition affecting 10-20% of patients with inflammatory bowel disease. Chronic, repeated inflammation and ulceration associated with healing lead to the formation of polyp-like structures in the colon. Although there are no common symptoms accompanying these pseudo-polyps, they can present with anemia, weight loss, diarrhea, intussusception, palpable mass, abdominal pain, discomfort, and melena, not to mention bowel obstruction that happens infrequently. Finally, it is important to recognize giant inflammatory polyps as they may occasionally be mistaken for colon cancer, leading to unnecessary surgical interventions. We present the case of a 38-year-old woman who was diagnosed with ulcerative colitis 10 years back, treated with oral mesalamine for five years, and had no follow-up after this period. She came to our clinic complaining of recurrent obstructive symptoms for a few months. Examination shows tenderness in the left lower quadrant with normal vital signs and bowel sounds.
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Affiliation(s)
| | | | | | | | - Khaled Alkhiari
- Department of Medicine, King Fahad Medical City, Riyadh, SAU
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3
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Ellul P, Schembri J, Baldacchino VA, Molnar T, Resal T, Allocca MA, Furfaro F, Dal Buono, Theodoropoulou A, Fragaki M, Tsoukali E, Mantzaris GJ, Phillips F, Radford S, Moran G, Gonzalez HA, Sebastian S, Fousekis F, Christodoulou D, Snir Y, Lerner Z, Yanai H, Michalopoulos G, Tua J, Camilleri L, Papamichael K, Karmiris K, Katsanos K. Post-inflammatory polyps burden as a prognostic marker of disease-outcome in patients with inflammatory bowel disease. J Crohns Colitis 2022; 17:489-496. [PMID: 36322687 DOI: 10.1093/ecco-jcc/jjac169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND AIM Post-inflammatory polyps (PIPs) are considered as indicators of previous episodes of severe inflammation and mucosal ulceration. Inflammatory bowel disease (IBD), namely Crohn's disease (CD) and ulcerative colitis (UC), exhibit a perpetuating, relapsing, and remitting pattern and PIPs is a frequent sequela of chronicity. The aim of this study was to determine whether a high PIPs burden is associated with a more severe disease course in patients with IBD. METHODS This was a multinational, multicentre, retrospective study. IBD patients previously diagnosed with PIPs were retrieved from the endoscopic database of each centre. PIPs burden was evaluated and associated with demographic and clinical data as well as factors indicating a more unfavorable disease course. RESULTS A total of 504 IBD patients with PIPs were recruited (male: 61.9%). The mean age at IBD diagnosis was 36.9 (±16.8) years. Most patients (74.8%) were diagnosed with UC. A high PIPs burden was present in 53.4% of patients. On multivariable Cox regression analysis, high PIPs burden was independently associated with treatment escalation (HR 1.35, 95% CI 1.04-1.75; P=0.024), hospitalization (HR 1.90; 95% CI 1.24 - 2.90; P=0.003), need for surgery (HR 2.28; 95% CI 1.17-4.44, P=0.02) and younger age at diagnosis (HR 0.99, 95% CI 0.98-0,99; p=0.003). CONCLUSION PIPs burden was associated with a more severe outcome. Future prospective studies should focus on the characterisation of PIPs burden as to further risk stratify this patient cohort.
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Affiliation(s)
- P Ellul
- Division of Gastroenterology, Mater Dei hospital, Malta
| | - J Schembri
- Division of Gastroenterology, Mater Dei hospital, Malta
| | | | - T Molnar
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Hungary
| | - T Resal
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Hungary
| | - M A Allocca
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - F Furfaro
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Dal Buono
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Theodoropoulou
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - M Fragaki
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - E Tsoukali
- Department of Gastroenterology, GHA "Evangelismos-Polykliniki', Athens, Greece
| | - G J Mantzaris
- Department of Gastroenterology, GHA "Evangelismos-Polykliniki', Athens, Greece
| | - F Phillips
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | - S Radford
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | - G Moran
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | | | - S Sebastian
- Hull University Teaching Hospitals, Hull, UK
| | - F Fousekis
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - D Christodoulou
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Y Snir
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Z Lerner
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - H Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - G Michalopoulos
- Gastroenterology department "Tzaneion" General Hospital of Piraeus, Greece
| | - J Tua
- Division of Gastroenterology, Mater Dei hospital, Malta
| | - L Camilleri
- Faculty of Science, University of Malta, Malta
| | - K Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - K Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - K Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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4
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alkhuzaie A, jameel W, sultan N, aldosari M. Filiform polyposis presenting with rapid growth and severe anemia case report. Int J Surg Case Rep 2022; 100:107771. [DOI: 10.1016/j.ijscr.2022.107771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/29/2022] [Accepted: 10/29/2022] [Indexed: 11/05/2022] Open
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Bratanic A, Despalatovic BR, Pavic B, Bozikovic T, Ardalic Z, Grubisic DA, Vilovic K. Obstructive Giant Inflammatory Polyposis as a First Manifestation of Crohn's Disease: A Case Report. Healthcare (Basel) 2022; 10:healthcare10101995. [PMID: 36292442 PMCID: PMC9601997 DOI: 10.3390/healthcare10101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 11/04/2022] Open
Abstract
Colonic inflammatory polyps (pseudopolyps) are common feature of inflammatory bowel diseases. They usually do not grow excessively, rarely reaching more than 15 mm in size, at which point they are termed giant inflammatory polyps. Clinical presentation of these polyps can vary greatly, ranging from being completely asymptomatic, usually detected incidentally, to abdominal cramps, rectal bleeding or intestinal obstruction. More importantly, giant inflammatory polyps can be easily mistaken for colonic malignancy, although without having malignant potential themselves. These polyps rarely regress with successful medical treatment of inflammatory bowel diseases and often require surgical treatment. We present an unusual case of giant inflammatory polyps which was the first presentation of inflammatory bowel disease. It was initially mistaken for colonic malignancy with intestinal obstruction, which led to surgical treatment.
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Affiliation(s)
- Andre Bratanic
- Department of Gastroenterology, University Hospital Split, 21000 Split, Croatia
| | - Bruna Rosic Despalatovic
- “J&J MEDICI” Polyclinic for Internal Medicine, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-915795288
| | - Berna Pavic
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Tina Bozikovic
- “J&J MEDICI” Polyclinic for Internal Medicine, 21000 Split, Croatia
| | - Zarko Ardalic
- Department of Gastroenterology, University Hospital Split, 21000 Split, Croatia
| | | | - Katarina Vilovic
- Department of Pathology, University Hospital Split, 21000 Split, Croatia
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Kasuga S, Anzai H, Makise N, Sonoda H, Nagai Y, Abe S, Yokoyama Y, Ozawa T, Emoto S, Murono K, Sasaki K, Kawai K, Nozawa H, Ushiku T, Ishihara S. Giant filiform polyposis with high-grade dysplasia: A case report and review of the literature. Ann Med Surg (Lond) 2022; 82:104433. [PMID: 36268352 PMCID: PMC9577439 DOI: 10.1016/j.amsu.2022.104433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- So Kasuga
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
- Corresponding author. Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hiroyuki Anzai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Naohiro Makise
- Department of Pathology, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Yuzo Nagai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Shinya Abe
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Yokoyama
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Ozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, The University of Tokyo, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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7
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Aslan J, Conley TE, Campbell F, Smith PJ, McNicol F, Andrews T, Subramanian S. Recurrent colonic polyps. Gut 2022; 71:888-960. [PMID: 33208406 DOI: 10.1136/gutjnl-2020-323133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Joseph Aslan
- Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Thomas E Conley
- Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Fiona Campbell
- Pathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Philip J Smith
- Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Frances McNicol
- Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Timothy Andrews
- Pathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sreedhar Subramanian
- Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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8
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Mantaka A, Bouklas DP, Vlachou E, Grammatikakis I, Papaconstantinou I, Tiniakos DG, Anagnostopoulou E. Inflammatory myoglandular polyp as a cause of recurrent abdominal pain in a patient with quiescent Crohn's disease. Ann Gastroenterol 2021; 34:888-890. [PMID: 34815656 PMCID: PMC8596221 DOI: 10.20524/aog.2021.0664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/13/2021] [Indexed: 11/11/2022] Open
Abstract
Chronic inflammation of the intestinal mucosa has been associated with the appearance of inflammatory polyps or pseudopolyps. Among the distinct categories of inflammatory polyps are inflammatory myoglandular polyps (IMGP) usually found in the colorectum. Only one case of IMGP in the terminal ileus has been described since their first description. We report the first case of an inflammatory polyp with both hyperplastic and myoglandular histological characteristics, in the terminal ileum of a patient with quiescent Crohn's disease, causing recurrent intussusception.
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Affiliation(s)
- Aikaterini Mantaka
- Department of Gastroenterology, "Saint George" General Hospital of Chania, Crete, Greece (Aikaterini Mantaka, Evaggelia Anagnostopoulou)
| | - Dimitrios P Bouklas
- Department of Pathology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (Dimitrios P. Bouklas, Dina G. Tiniakos)
| | - Erasmia Vlachou
- Gastroenterology Department, Army Share Fund Hospital (NIMTS), Athens Greece (Erasmia Vlachou)
| | - Ioannis Grammatikakis
- Department of Radiology, University Hospital of Heraklion, University of Crete Medical School (Ioannis Grammatikakis, Ioannis Papaconstantinou)
| | - Ioannis Papaconstantinou
- 2 Department of Surgery, Areteion Hospital, National and Kapodistrian University of Athens, Athens, Greece (Ioannis Papaconstantinou)
| | - Dina G Tiniakos
- Department of Pathology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (Dimitrios P. Bouklas, Dina G. Tiniakos).,Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK (Dina G. Tiniakos)
| | - Evaggelia Anagnostopoulou
- Department of Gastroenterology, "Saint George" General Hospital of Chania, Crete, Greece (Aikaterini Mantaka, Evaggelia Anagnostopoulou)
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9
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Ma YR, Polydorides AD. Clinicopathologic Characteristics and Neoplasia Risk of Colorectal Inflammatory Polyposis in Inflammatory Bowel Disease. Arch Pathol Lab Med 2021; 146:172-181. [PMID: 33946102 DOI: 10.5858/arpa.2020-0745-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/11/2022]
Abstract
CONTEXT.— Inflammatory polyps (IPs) in inflammatory bowel disease may have been associated in the past with increased neoplasia risk. Additionally, colonic mucosa in filiform polyposis and giant inflammatory polyposis may be difficult to visualize during endoscopic surveillance, perhaps contributing to early colectomy in these patients. OBJECTIVE.— To examine the clinicopathologic characteristics and significance of IPs and inflammatory polyposis in inflammatory bowel disease. DESIGN.— We identified 336 resections from inflammatory bowel disease patients (212 [63.1%] male; mean age, 40.3 years; 175 [52.1%] with ulcerative colitis), including 78 with rare/few (<10) IPs, 141 with multiple (≥10) IPs, and 117 with inflammatory polyposis (including 30 with filiform polyposis/giant inflammatory polyposis) and compared them with 100 controls without IPs along various parameters, including overall and occult (unexpected) dysplasia. RESULTS.— There was no increased neoplasia in resections with IPs compared with controls, given similar age, disease duration, degree of inflammation, anatomical extent of colitis, prevalence of primary sclerosing cholangitis, and tissue sampling. Increasing numbers of IPs and inflammatory polyposis were significantly associated in multivariate analysis with ulcerative and indeterminate colitis (P = .003) and shorter disease duration (P = .01), but also, and independently, with lower rates of dysplasia overall, including all grades (P = .001) and advanced neoplasia (P = .04). There were no instances of occult dysplasia (any grade) among inflammatory polyposis cases. CONCLUSIONS.— These findings support the conclusion that the presence of IPs per se, and inflammatory polyposis in particular (including filiform polyposis and giant inflammatory polyposis), should not be considered an independent risk factor for the development of neoplasia in inflammatory bowel disease patients, outside the context of disease duration and inflammatory burden.
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Affiliation(s)
- Yihong R Ma
- From the Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Ma is now at West Florida Hospital in Pensacola
| | - Alexandros D Polydorides
- From the Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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10
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Katerji R, Huber AR. Giant Inflammatory Polyps in Diverticular Disease Mimicking a Colonic Mass: A Potential Malignant Masquerader. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923242. [PMID: 32595204 PMCID: PMC7347030 DOI: 10.12659/ajcr.923242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inflammatory pseudopolyps (IPPs) are a common manifestation in inflammatory bowel disease (IBD) with more cases reported with ulcerative colitis than Crohn's disease. IPPs can grow to form large polyps which are called giant inflammatory polyps (GIPs). These polyps may cause an obstruction and form a mass-like lesion and surgical resection may be warranted. CASE REPORT A 65-year-old male without a previous history of IBD presented with abdominal discomfort, poor appetite, constipation, weight loss, and hematochezia. Due to the high suspicion of malignancy, a computed tomography (CT) scan was performed and showed a fixed lesion in the mid sigmoid colon highly concerning for a primary colon carcinoma, with scattered diverticula, and associated with elevated carcinoembryonic antigen (CEA). Colonoscopy was done but the scope could not be passed due to obstruction. Sigmoidectomy was performed which showed a huge noninvasive lesion, which looked like pseudopolypoid serpiginous mass as giant inflammatory polyp, with scattered diverticula. On microscopic examination, pathology showed a villous polyp with numerous inflammatory cells, without any dysplasia or carcinoma. CONCLUSIONS GIPs are rarely reported without a history of IBD. Diagnosis of GIPs can be very challenging, and surgery is sometimes indicated for definitive diagnosis.
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Affiliation(s)
- Roula Katerji
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA
| | - Aaron R Huber
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA
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11
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Karaskova E, Veghova-Velganova M, Geryk M. Giant post-inflammatory polyposis in a child with ulcerative colitis: A case report. Int J Surg Case Rep 2020; 77:249-251. [PMID: 33189004 PMCID: PMC7672246 DOI: 10.1016/j.ijscr.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 10/26/2022] Open
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12
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Le Berre C, Ananthakrishnan AN, Danese S, Singh S, Peyrin-Biroulet L. Ulcerative Colitis and Crohn's Disease Have Similar Burden and Goals for Treatment. Clin Gastroenterol Hepatol 2020; 18:14-23. [PMID: 31301452 DOI: 10.1016/j.cgh.2019.07.005] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/23/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
Abstract
It is unclear whether ulcerative colitis (UC) is a progressive disease similar to Crohn's disease (CD). Patients with UC often are undertreated because of the possibility of curative colectomy and the perception that the disease burden is lower than that of CD. We discuss findings from studies that aimed to determine whether UC and CD have the same disease burden and should be treated in the same intensive way. We discuss the similarities between CD and UC, including effects on quality of life, long-term complications, strictures, increased risk of cancer, pseudopolyps, functional abnormalities, and anorectal dysfunction. Contrary to the generally accepted idea, surgery cannot cure UC. Postoperative complications, especially pouchitis and fecal incontinence, affect more than one third of patients. CD and UC each pose substantial economic burdens. Monitoring, treatments, and goals of therapy are similar for all inflammatory bowel diseases. Earlier initiation of disease-modifying drugs might reduce the progression of UC and reduce its burden after surgery, although UC might not cause the irreversible damage observed in patients with CD.
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Affiliation(s)
- Catherine Le Berre
- Inserm U954, Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France; Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | | | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - Siddharth Singh
- Division of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Laurent Peyrin-Biroulet
- Inserm U954, Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France.
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Rezapour M, Quintero MA, Khakoo NS, Sussman DA, Barkin JA, Clarke J, Varma T, Deshpande AR, Kerman DH, Damas O, Abreu MT. Reclassifying Pseudopolyps in Inflammatory Bowel Disease: Histologic and Endoscopic Description in the New Era of Mucosal Healing. CROHN'S & COLITIS 360 2019; 1:otz033. [PMID: 31667471 PMCID: PMC6798790 DOI: 10.1093/crocol/otz033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION In this study, we identify the frequency of pseudopolyps (PPs) with normal histology and their association to surrounding tissue. METHODS Patients were enrolled in a study identifying endoscopic characteristics of PPs (n = 29) or were collected as part of our IBD biobank (n = 16). Statistical analysis included Stata v.15.0. chi-square and Student t-test. RESULTS A total of 45 patients with 117 PP biopsies were identified. More patients with healed PP were in endoscopic remission compared with those with inflammatory PP (82.6% vs 17.4%, respectively). CONCLUSION This is the first study to find mucosal healing of PPs and its association with deep remission.
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Affiliation(s)
- Mona Rezapour
- Department of Gastroenterology and Hepatology, University of California Los Angeles, Los Angeles, California
| | | | - Nidah S Khakoo
- Department of Medicine, University of Miami, Miami, Florida
| | - Daniel A Sussman
- Department of Gastroenterology and Hepatology, University of Miami, Miami, Florida
| | - Jodie A Barkin
- Department of Gastroenterology and Hepatology, University of Miami, Miami, Florida
| | - Jennifer Clarke
- Nebraska Food for Health Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska
| | | | - Amar R Deshpande
- Department of Gastroenterology and Hepatology, University of Miami, Miami, Florida
| | - David H Kerman
- Department of Gastroenterology and Hepatology, University of Miami, Miami, Florida
| | - Oriana Damas
- Department of Gastroenterology and Hepatology, University of Miami, Miami, Florida
| | - Maria T Abreu
- Department of Gastroenterology and Hepatology, University of Miami, Miami, Florida
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Amini A, Vaezi Z, Talebian A, Koury E, Chahla E. Does the Presence of Giant Pseudopolyps in a Patient with Newly Diagnosed Inflammatory Bowel Disease Increase the Risk of Major Thrombotic Events? Case Rep Gastroenterol 2019; 13:468-474. [PMID: 31824235 DOI: 10.1159/000504407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/29/2019] [Indexed: 11/19/2022] Open
Abstract
Giant inflammatory polyp and thromboembolism are uncommon complications in inflammatory bowel disease (IBD) patients. Colon mucosal inflammation is possibly the main mechanism of pathogenesis for these two complications. IBD has long been associated with hypercoagulability and thromboembolism. In fact, thromboembolism has been noted in 0.7% to 7.7% of IBD patients, with the deep veins of the legs and the pulmonary veins accounting for 90% of the cases. The proposed mechanism of this hypercoagulability involves the promotion of hemostasis that results from the inflammatory process underlying the IBD, as well as the loss of proteins, including antithrombotic factors, resulting from the inflamed bowel and increased permeability of the colonic mucosa. This process may be exacerbated by the presence of giant inflammatory polyps, which are defined as polyps in the setting of IBD with dimensions greater than 1.5 cm. The presence of these polyps leads to an increase in inflamed colonic surface area, which can accelerate the rate of protein loss, leading to an increased incidence of thrombosis. Here, we report the case of a 21-year-old female with inferior vena cava and left renal vein thromboses secondary to a newly diagnosed IBD and the presence of severe giant inflammatory polyposis. These thromboses were detected incidentally in this patient after 1 week of hospitalization. She had presented with hypoalbuminemia and elevated inflammatory markers, which raised the suspicion for possible giant inflammatory polyposis as a potential risk for her major thromboembolic events. More studies are required to explore this plausible correlation further.
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Affiliation(s)
- Afshin Amini
- Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri, USA
| | - Zahra Vaezi
- Department of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Amirsina Talebian
- Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri, USA
| | - Elliott Koury
- Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri, USA
| | - Elie Chahla
- Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri, USA
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15
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Complete Regression of Giant Inflammatory Polyp after Treatment with Adalimumab. Case Rep Gastrointest Med 2019; 2019:5347637. [PMID: 30984431 PMCID: PMC6431470 DOI: 10.1155/2019/5347637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/13/2019] [Indexed: 12/22/2022] Open
Abstract
Giant inflammatory polyps (GIPs) are a rare complication of IBD resulting from chronic regenerative and healing processes leading to a polypoid formation on inflamed mucosa. We reported a case of GIP in a patient with long standing left-sided ulcerative colitis (UC); a well circumscribed sessile GIP was found during a colonoscopy for colorectal cancer screening on a normal colonic mucosa in the cecum. After a severe flare of the left-sided colitis and due to partial response to steroids patient was treated with adalimumab; new colonoscopy after 6 months shows complete disappearance of the GIP previously described. It is the first case report of GIP in normal macroscopic mucosa with complete disappearance after biologic treatment.
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16
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Politis DS, Papamichael K, Katsanos KH, Koulouridis I, Mavromati D, Tsianos EV, Christodoulou DK. Presence of pseudopolyps in ulcerative colitis is associated with a higher risk for treatment escalation. Ann Gastroenterol 2019; 32:168-173. [PMID: 30837789 PMCID: PMC6394261 DOI: 10.20524/aog.2019.0357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/27/2018] [Indexed: 12/17/2022] Open
Abstract
Background Pseudopolyps in ulcerative colitis (UC) are considered as indicators of previous episodes of severe inflammation and ulceration of the mucosa. The aim of the study was to investigate the long-term outcomes of patients treated for UC, with or without pseudopolyps. Methods This was a retrospective single-center study. Consecutive patients with UC and available endoscopic data from 2000 until 2016 were eligible for the study and were followed until June 2017. Patients with incomplete medical/endoscopic charts or interrupted follow up were excluded from the study. Primary outcomes included time to treatment escalation, treatment escalation to biological agents or surgery, and UC-related hospitalization. Results Eighty-three UC patients were included in the study, of whom 25 (30%) had pseudopolyps. The median duration of follow up was 2.8 years (interquartile range: 1.1-4.9). Multiple Cox regression analysis identified the presence of pseudopolyps as the only variable independently associated with treatment escalation (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.2-4.3; P=0.014) and escalation to biological agents or surgery (HR 6.3, 95%CI 1.9-20.7; P=0.002). Conclusion This retrospective single-center study provides the first preliminary evidence that patients with UC and pseudopolyps may represent a subpopulation with a higher inflammatory burden and a greater need for treatment escalation, including to biological agents or surgery. Large, prospective multicenter studies are certainly warranted to confirm these findings.
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Affiliation(s)
- Dimitrios S Politis
- Department of Gastroenterology, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Dimitrios S. Politis, Konstantinos H. Katsanos, Epameinondas V. Tsianos, Dimitrios K. Christodoulou)
| | - Konstantinos Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (Konstantinos Papamichael)
| | - Konstantinos H Katsanos
- Department of Gastroenterology, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Dimitrios S. Politis, Konstantinos H. Katsanos, Epameinondas V. Tsianos, Dimitrios K. Christodoulou)
| | - Ioannis Koulouridis
- Center for Clinical Evidence Synthesis, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA (Ioannis Koulouridis)
| | | | - Epameinondas V Tsianos
- Department of Gastroenterology, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Dimitrios S. Politis, Konstantinos H. Katsanos, Epameinondas V. Tsianos, Dimitrios K. Christodoulou)
| | - Dimitrios K Christodoulou
- Department of Gastroenterology, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Dimitrios S. Politis, Konstantinos H. Katsanos, Epameinondas V. Tsianos, Dimitrios K. Christodoulou)
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17
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Sánchez Melgarejo JF, Rubio Mateos JM, Sánchez Fernández MJ, Pérez Fernández A, Martínez Andrés B. Regression of a giant pseudopolyp in a patient with colonic Crohn�s disease after therapy with infliximab. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:801-803. [DOI: 10.17235/reed.2019.6252/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Farkas NG, Welman TJP, Ross T, Brown S, Smith JJ, Pawa N. Unusual causes of large bowel obstruction. Curr Probl Surg 2018; 56:49-90. [PMID: 30777150 DOI: 10.1067/j.cpsurg.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nicholas G Farkas
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | - Ted Joseph P Welman
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Talisa Ross
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Brown
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jason J Smith
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nikhil Pawa
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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19
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Slim R, Aoun N. Abnormal growth. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 29:509-510. [PMID: 30249568 DOI: 10.5152/tjg.2018.18130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Rita Slim
- Department of Gastroenterology, Saint Joseph University of Beirut, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Noel Aoun
- Department of Radiology, Saint Joseph University of Beirut, Hotel-Dieu de France Hospital, Beirut, Lebanon
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20
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Obstructive Giant Inflammatory Polyposis: Is It Related to the Severity or the Duration of the Inflammatory Bowel Disease? Two Case Reports. Case Rep Gastrointest Med 2018; 2018:3251549. [PMID: 29984012 PMCID: PMC6015717 DOI: 10.1155/2018/3251549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/17/2018] [Indexed: 02/07/2023] Open
Abstract
We report two cases of giant inflammatory polyposis (GIP) with totally different presentation and evolution. The first patient had two giant pseudopolyps after one year of the diagnosis of UC. The second patient had one obstructive giant pseudopolyp secondary to CD at the level of the transverse colon, being totally asymptomatic years before the presentation. GIP is a rare complication of inflammatory bowel disease (IBD). It consists of numerous filiform polyps that look like a "mass of worms" or a "fungating" mass. Surgical resection is inevitable when GIP presents with obstructive symptoms.
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21
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Massinha P, Portela F, Campos S, Duque G, Ferreira M, Mendes S, Ferreira AM, Sofia C, Tomé L. Ulcerative Colitis: Are We Neglecting Its Progressive Character. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:74-79. [PMID: 29662931 DOI: 10.1159/000481263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/19/2017] [Indexed: 12/22/2022]
Abstract
Introduction Ulcerative colitis (UC) is a chronic disease but its progressive character, with structural damage, is insufficiently studied. Objectives To analyze a group of patients without referral bias, regarding its clinical course, the morphological damage, and functional status. Methods We evaluated UC patients diagnosed between January 1, 2000 and December 31, 2004, living in the direct referral area of the hospital and determined the medication use, colectomy rate, structural damage ("lead pipe," stenosis, pseudopolyps, fibrous bridges), and anorectal function (prospective evaluation with the Cleveland Clinic Incontinence Score [CCIS] and the Fecal Incontinence Quality of Life Scale). Results We identified 104 patients, 47% female, with a mean age at diagnosis of 38 ± 17 years, 24% with proctitis, 57% with left colitis, and 19% with pancolitis. In 3 patients, it was not possible to obtain follow-up data. Of the studied patients, 56% needed corticosteroid therapy, 38% immunosuppressants, and 16% anti-tumor necrosis factors (anti-TNFs). After a mean follow-up of 13 ± 2 years, we found structural damage in 25 patients (24%): 5% with proctocolectomy, 15% with "lead pipe," 16% with pseudopolyps, and 3% with stenosis and fibrous bridges. Reference to functional anorectal disorders was identified in 49%, mostly previous and self-limited episodes of incontinence, but including persistent incontinence in 10% (CCIS 8 ± 4.8). There was an increased incidence of structural damage and anorectal dysfunction in patients who needed corticosteroid therapy (p = 0.001), immunosuppressants (p < 0.001), and anti-TNFs (p = 0.002) and an association of structural damage with anorectal dysfunction (p < 0.001). There was no association between age and anorectal dysfunction, including incontinence episodes. Conclusions UC is a disease with structural and functional consequences in a significant subset of patients. This should be incorporated when defining the therapeutic strategy.
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Affiliation(s)
- Paulo Massinha
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Francisco Portela
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Sara Campos
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Gabriela Duque
- Department of Gastroenterology, Hospital Distrital da Figueira da Foz, EPE, Figueira da Foz, Portugal
| | - Manuela Ferreira
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Sofia Mendes
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Ana Margarida Ferreira
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Carlos Sofia
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Luís Tomé
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
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Romero C, Sirsi S, Asarian A, Levine J, Xiao P. Giant inflammatory polyposis, a phenomenon of inflammatory bowel disease, presenting as acute large bowel obstruction mimicking colonic neoplasm. J Surg Case Rep 2017; 2017:rjx174. [PMID: 28928929 PMCID: PMC5597882 DOI: 10.1093/jscr/rjx174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/23/2017] [Indexed: 01/18/2023] Open
Abstract
Inflammatory bowel disease (IBD) remains a topic of ongoing research given its prevalence, yet the pathogenesis and all clinical manifestations of the disease remain poorly understood. Giant inflammatory polyposis is one of the clinical manifestations of IBD that has rarely been described to the best of our knowledge. This is a recognized clinical entity, however, only a limited number of IBD associated cases have been described in literature to date. This phenomenon consists of numerous benign, inflammatory polyps that clump together giving the appearance of a larger mass, which may cause clinical colonic obstruction and radiographic findings mimicking colonic neoplasm. This clinical entity may present in 10-20% of patients with IBD.
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Affiliation(s)
- Christina Romero
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA
| | - Sandeep Sirsi
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA
| | - Armand Asarian
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA
| | - Jun Levine
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA
| | - Philip Xiao
- Department of Pathology, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA
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Politis DS, Katsanos KH, Tsianos EV, Christodoulou DK. Pseudopolyps in inflammatory bowel diseases: Have we learned enough? World J Gastroenterol 2017; 23:1541-1551. [PMID: 28321155 PMCID: PMC5340806 DOI: 10.3748/wjg.v23.i9.1541] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/20/2017] [Accepted: 02/16/2017] [Indexed: 02/06/2023] Open
Abstract
Pseudopolyps are a well described entity in the literature and even though the exact pathogenesis of their formation is not completely understood, they are considered non-neoplastic lesions originating from the mucosa after repeated periods of inflammation and ulceration associated with excessive healing processes. Their occurrence is less common in Crohn's disease than in ulcerative colitis, and their overall prevalence ranges from 4% to 74%; moreover, they are found more often in colon but have been detected in other parts of the gastrointestinal tract as well. When their size exceeds the arbitrary point of 1.5 cm, they are classified as giant pseudopolyps. Clinical evaluation should differentiate the pseudopolyps from other polypoid lesions, such as the dysplasia-associated mass or lesion, but this situation represents an ongoing clinical challenge. Pseudopolyps can provoke complications such as bleeding or obstruction, and their management includes medical therapy, endoscopy and surgery; however, no consensus exists about the optimal treatment approach. Patients with pseudopolyps are considered at intermediate risk for colorectal cancer and regular endoscopic monitoring is recommended. Through a review of the literature, we provide here a proposed classification of the characteristics of pseudopolyps.
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Recurrent Obstructive Giant Inflammatory Polyposis of the Colon. ACG Case Rep J 2016; 3:e89. [PMID: 27807551 PMCID: PMC5062662 DOI: 10.14309/crj.2016.62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/04/2016] [Indexed: 01/06/2023] Open
Abstract
Inflammatory polyps are relatively common in patients with inflammatory bowel disease. The term giant inflammatory polyposis is used to describe inflammatory polyps greater than 1.5 cm in any dimension. Their clinical presentation can be varied, ranging from asymptomatic, with incidental detection on radiological or endoscopic testing, to symptomatic, with rectal bleeding and colonic obstruction. Although giant inflammatory polyposis is a rare finding, it is of clinical importance, since it is easily mistaken for colon cancer, with patients sometimes undergoing radical surgeries. We describe an unusual case of giant inflammatory polyposis causing recurrent symptomatic obstruction despite multiple segmental colectomies in a patient with indeterminate colitis. This is the first such reported case in English literature to the best of our knowledge.
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25
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Feng JS, Ye Y, Guo CC, Luo BT, Zheng XB. Ulcerative colitis with inflammatory polyposis in a teenage boy: A case report. World J Gastroenterol 2015; 21:1044-1048. [PMID: 25624746 PMCID: PMC4299325 DOI: 10.3748/wjg.v21.i3.1044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/31/2014] [Accepted: 09/19/2014] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis in addition to inflammatory polyposis is common. The benign sequel of ulcerative colitis can sometimes mimic colorectal carcinoma. This report describes a rare case of inflammatory polyposis with hundreds of inflammatory polyps in ulcerative colitis which was not easy to distinguish from other polyposis syndromes. A 16-year-old Chinese male suffering from ulcerative colitis for 6 mo underwent colonoscopy, and hundreds of polyps were observed in the sigmoid, causing colonic stenosis. The polyps were restricted to the sigmoid. Although rectal inflammation was detected, no polyps were found in the rectum. A diagnosis of inflammatory polyposis and ulcerative colitis was made. The patient underwent total colectomy and ileal pouch anal anastomosis. The patient recovered well and was discharged on postoperative day 8. Endoscopic surveillance after surgery is crucial as ulcerative colitis with polyposis is a risk factor for colorectal cancer. Recognition of polyposis requires clinical, endoscopic and histopathologic correlation, and helps with chemoprophylaxis of colorectal cancer, as the drugs used postoperatively for colorectal cancer, ulcerative colitis and polyposis are different.
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26
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Naymagon S, Mikulasovich M, Gui X, Ullman TA, Harpaz N. Crohn's-like clinical and pathological manifestations of giant inflammatory polyposis in IBD: a potential diagnostic pitfall. J Crohns Colitis 2014; 8:635-40. [PMID: 24368253 DOI: 10.1016/j.crohns.2013.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/25/2013] [Accepted: 11/26/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Giant inflammatory polyposis (GIP), characterized by mass-like agglomerations of inflammatory polyps, is a rare complication of inflammatory bowel disease (IBD). We reviewed a series of cases of GIP to determine its diagnostic impact on the clinical and pathologic distinction between ulcerative colitis (UC) and colonic Crohn's disease (CD). METHODS All colons with GIP resected over a 13-year period were identified prospectively and the corresponding clinical and pathologic records were reviewed. RESULTS Twelve cases of GIP were identified, accounting for 0.8% of colectomies for IBD during the same time interval. Preoperatively, 6 (50%) patients were diagnosed with UC, 2 (17%) with CD and 4 (33%) with indeterminate colitis (IC). Postoperatively, 6 of the diagnoses (50%) were revised based on strict histopathologic criteria: all 4 diagnoses of IC to UC, one diagnosis of CD to UC, and one diagnosis of UC to CD, for a total of 10 diagnoses of UC (83%) and two of CD (17%). Significantly, 7 of 10 cases with postoperative diagnoses of UC (70%) had Crohn's-like transmural inflammation exclusively within the polyposis segments attributed to fecal entrapment and stasis and accounting for the Crohn's-like clinical complications in these cases. CONCLUSIONS This case series of GIP, the largest reported from a single center, highlights the high rate of Crohn's-like clinical and pathological manifestations of GIP and their potential to confound the accurate classification of patients with IBD. A diagnosis of UC should not be amended to CD based on the findings of the polyposis segment alone.
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Affiliation(s)
- Steven Naymagon
- Department of Medicine and The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, United States.
| | - Michael Mikulasovich
- Department of Pathology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, United States
| | - Xianyong Gui
- Department of Pathology and Laboratory Service, University of Calgary, Calgary, AB, Canada
| | - Thomas A Ullman
- Department of Medicine and The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, United States
| | - Noam Harpaz
- Department of Medicine and The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, United States; Department of Pathology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, United States
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27
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Hokama A, Nagahama M, Kishimoto K, Fujita J. Colonic stricture with filiform polyposis in Crohn's disease. BMJ Case Rep 2014; 2014:bcr-2014-204710. [PMID: 24825561 DOI: 10.1136/bcr-2014-204710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Akira Hokama
- Department of Endoscopy, University of the Ryukyus, Nishihara, Japan
| | - Masayoshi Nagahama
- Department of Digestive and General Surgery, University of the Ryukyus, Nishihara, Japan
| | - Kazuto Kishimoto
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Nishihara, Japan
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Nishihara, Japan
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28
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Torres J, Billioud V, Sachar DB, Peyrin-Biroulet L, Colombel JF. Ulcerative colitis as a progressive disease: the forgotten evidence. Inflamm Bowel Dis 2012; 18:1356-63. [PMID: 22162423 DOI: 10.1002/ibd.22839] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 10/31/2011] [Indexed: 12/12/2022]
Abstract
In the management of Crohn's disease, earlier aggressive treatment is becoming accepted as a strategy to prevent or retard progression to irreversible bowel damage. It is not yet clear, however, if this same concept should be applied to ulcerative colitis. Hence, we review herein the long-term structural and functional consequences of this latter disease. Disease progression in ulcerative colitis takes six principal forms: proximal extension, stricturing, pseudopolyposis, dysmotility, anorectal dysfunction, and impaired permeability. The precise incidence of these complications and the ability of earlier, more aggressive treatment to prevent them have yet to be determined.
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Affiliation(s)
- Joana Torres
- Henry D. Janowitz Division of Gastroenterology, Mount Sinai School of Medicine, New York, New York 10029-6754, USA
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29
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Choi YS, Suh JP, Lee IT, Kim JK, Lee SH, Cho KR, Park HJ, Kim DS, Lee DH. Regression of giant pseudopolyps in inflammatory bowel disease. J Crohns Colitis 2012; 6:240-3. [PMID: 22325179 DOI: 10.1016/j.crohns.2011.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 08/03/2011] [Accepted: 08/11/2011] [Indexed: 12/13/2022]
Abstract
Inflammatory pseudopolyps are formed in the regenerative and healing phases of ulcerated epithelium. Giant pseudopolyposis of the colon (pseudopolyp larger than 1.5 cm in size) is a very rare complication of inflammatory bowel disease and it may lead to colonic intussusception or luminal obstruction, but the more important clinical significance is that it can be endoscopically confused with a malignancy, although it is generally regarded as having no malignant potential. It has been reported that giant pseudopolyposis of the colon rarely regresses with medical management alone and this sometimes require surgical or endoscopic resection. This report illustrates 2 unusual cases of giant pseudopolyps associated with Crohn's disease and ulcerative colitis, and these giant pseudopolyps were initially confused with villous adenoma or adenocarcinoma, but they showed regression after adequate medical therapy.
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Affiliation(s)
- Yong Sung Choi
- Department of Gastroenterology, Daehang Hospital, Seoul, South Korea.
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