To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. ...To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. METHODSTwenty pathologically and clinically confirmed CMUSE patients (males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series (SBS; n = 25), computed tomography (CT) enterography (n = 21), magnetic resonance (MR) enterography (n = 2), and abdominopelvic CT (n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during follow-up period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTSThe main symptoms were abdominal pain (n = 12) and anemia (n = 10). All patients showed small bowel strictures (n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum (n = 47) or jejunum (n = 5). Strictures showed short-length (mean: 10.44 mm) and circumferential bowel wall thickening (mean: 5.56 mm) with layered enhancement (n = 48) that were also noted on initial SBS (n = 36) with shallow ulcers (n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on follow-up SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence (median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures. CONCLUSIONUnder characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.展开更多
Apart from alcohol,there are other factors that may induce complications,which resemble alcohol-related liver disorders.In particular,obesity has been brought into focus as a risk factor for fatty liver disease.The te...Apart from alcohol,there are other factors that may induce complications,which resemble alcohol-related liver disorders.In particular,obesity has been brought into focus as a risk factor for fatty liver disease.The term "non-alcoholic" fatty liver disease is commonly used to distinguish between obesity-related and alcohol-related hepatic steatosis.This review uses the epidemiological perspective to critically assess whether it is necessary and useful to differentiate between alcoholic and "nonalcoholic" fatty liver disease.The MEDLINE database was searched using the PubMed search engine,and a review of reference lists from original research and review articles was conducted.The concept to distinguish between alcoholic and "non-alcoholic" fatty liver disease is mainly based on specific pathomechanisms.This concept has,however,several limitations including the common overlap between alcohol misuse and obesityrelated metabolic disorders and the non-consideration of additional causal factors.Both entities share similar histopathological patterns.Studies demonstrating differences in clinical presentation and outcome are often biased by selection.Risk factor reduction is the main principle of prevention and treatment of both disease forms.In conclusion,alcoholic and "non-alcoholic" fatty liver diseases are one and the same disease caused by different risk factors.A shift from artificial categories to a more general approach to fatty liver disease as a multicausal disorder may optimize preventive strategies and help clinicians more effectively treat patients at the individual level.展开更多
文摘To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. METHODSTwenty pathologically and clinically confirmed CMUSE patients (males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series (SBS; n = 25), computed tomography (CT) enterography (n = 21), magnetic resonance (MR) enterography (n = 2), and abdominopelvic CT (n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during follow-up period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTSThe main symptoms were abdominal pain (n = 12) and anemia (n = 10). All patients showed small bowel strictures (n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum (n = 47) or jejunum (n = 5). Strictures showed short-length (mean: 10.44 mm) and circumferential bowel wall thickening (mean: 5.56 mm) with layered enhancement (n = 48) that were also noted on initial SBS (n = 36) with shallow ulcers (n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on follow-up SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence (median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures. CONCLUSIONUnder characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.
文摘Apart from alcohol,there are other factors that may induce complications,which resemble alcohol-related liver disorders.In particular,obesity has been brought into focus as a risk factor for fatty liver disease.The term "non-alcoholic" fatty liver disease is commonly used to distinguish between obesity-related and alcohol-related hepatic steatosis.This review uses the epidemiological perspective to critically assess whether it is necessary and useful to differentiate between alcoholic and "nonalcoholic" fatty liver disease.The MEDLINE database was searched using the PubMed search engine,and a review of reference lists from original research and review articles was conducted.The concept to distinguish between alcoholic and "non-alcoholic" fatty liver disease is mainly based on specific pathomechanisms.This concept has,however,several limitations including the common overlap between alcohol misuse and obesityrelated metabolic disorders and the non-consideration of additional causal factors.Both entities share similar histopathological patterns.Studies demonstrating differences in clinical presentation and outcome are often biased by selection.Risk factor reduction is the main principle of prevention and treatment of both disease forms.In conclusion,alcoholic and "non-alcoholic" fatty liver diseases are one and the same disease caused by different risk factors.A shift from artificial categories to a more general approach to fatty liver disease as a multicausal disorder may optimize preventive strategies and help clinicians more effectively treat patients at the individual level.
