Intestinal Distension Research Articles

Severe hepatic portal venous gas that spontaneously resolved within a day

A 76-year-old man, without any surgical history, presented with disturbance of consciousness. Physical examination indicated abdominal distension without bowel sounds. Laboratory data revealed an elevated white blood cell count (14,400/lL) and lactate dehydrogenase level, but no elevated C-reactive protein level (0.34 mg/ dL), hepatic dysfunction, or hyperammonemia. Abdominal computed tomography revealed hepatic portal venous gas (HPVG) and intestinal distension (Fig. 1a). Owing to the stable vital signs and lack of bowel ischemia, surgery was not performed. After bowel movements and excretion of large stool, the HPVG disappeared (Fig. 1b). Upper endoscopy and colonoscopy findings were normal. After 23 days, the patient was fully conscious and was discharged. HPVG is rarely noted on imaging and its pathogenesis remains unclear. Mesenteric vascular occlusion, bowel ischemia, and subsequent bowel necrosis, due to the presence of gas-forming bacteria in the portal venous system, may cause the passage of gas into the circulation, which is a common cause of HPVG. Although this condition is rare, digestive tract dilatation, gastric ulcer, ulcerative colitis, Crohn disease, or endoscopic procedure complications may increase the pressure in the bowel lumen, thus causing gas to escape from the circulation into the liver, which may have caused HPVG in our case.

Severe Intestinal Distension in a Dog with Primary Hypoparathyroidism

An 1-year-old, female, mixed-breed dog weighing 17 kg was referred for abrupt collapse. She had remarkable hypocalcemia and hyperphosphatemia, and survey radiographs revealed a severe gas-filled intestine. Treatment with serial injections of calcium gluconate was initiated promptly and most of the gastrointestinal distension disappeared after 4 h. However, the clinical signs were not resolved completely. The serum intact parathyroid hormone concentration was not elevated in the context of hypocalcemia, which suggested primary hypoparathyroidism. The clinical signs and laboratory abnormalities in the patient were resolved completely 3 days after administration of calcium gluconate and calcitriol. This case describes the unique presentation of severe gastrointestinal distension in a dog diagnosed with primary hypoparathyroidism.

Comparative Pathology of Neurovirulent Lineage 1 (NY99/385) and Lineage 2 (SPU93/01) West Nile Virus Infections in BALBc Mice

The pathology in mice infected with neurovirulent South African lineage 2 West Nile virus (WNV) strains has not previously been described. Three- to 4-month-old male BALBc mice were infected with South African neurovirulent lineage 2 (SPU93/01) or lineage 1 (NY385/99) WNV strains and the gross and microscopic central nervous system (CNS) and extra-CNS pathology of both investigated and compared. Mice infected with both lineages showed similar illness, paralysis, and death from days 7 to 11 postinfection (PI). Two survivors of each lineage were euthanized on day 21 PI. WNV infection was confirmed by nested real-time reverse transcription polymerase chain reaction of tissues, mostly brain, in the majority of mice euthanized sick or that died and in 1 healthy lineage 2 survivor. Gross lesions caused by both lineages were identical and included marked gastric and proximal small intestinal fluid distension as described in a previous mouse study, but intestinal microscopic lesions differed. CNS lesions were subtle. Immunohistochemical (IHC)-positive labeling for WNV E protein was found in neurons multifocally in the brain of 3 lineage 1-infected and 3 lineage 2-infected mice from days 9 to 11 PI, 4 of these including brainstem neurons, and of cecal myenteric ganglion neurons in 1 lineage 2-infected day 8 PI mouse. Findings supported hypotheses in hamsters that gastrointestinal lesions are likely of brainstem origin. Ultrastructurally, virus-associated cytoplasmic vesicular or crystalline structures, or amorphous structures, were found to label IHC positive in control-positive avian cardiomyocytes and mouse thalamic neurons, respectively, and WNV-like 50-nm particles, which were scarce, did not label.

Gut Motility Alterations in Neonates and Young Infants

C olic usually affects babies in the first few weeks of their lives and persists for about 4 months. Crying can be intense and furious and it may last for several hours per day for several weeks. Although crying can occur at any time, it is usually worse in the late afternoon and evening, and occasionally affects the baby’s sleep. Infantile colic is not considered a disease, fulfilling instead criteria for a functional disorder. Research shows that babies with colic continue to eat and gain weight appropriately, despite the crying (1). The main risk for these babies relates to the stress and anxiety that the condition creates at home, especially when it affects the first child. The cause of colic is not known. Painful flatus may contribute to colic, but there is little evidence to prove that it is linked to digestive problems (2). Another theory is that while the digestive system is maturing, some babies are more sensitive to substances such as lactose ingested through breast-feeding and formula milk; however, evidence to support this hypothesis also is limited. Other possible causes relate to the baby’s behavior and temperament. Among the gastrointestinal (GI) factors, we focus on non-nutritive pathophysiology such as the relation of colic to gastroesophageal reflux (GER), GI motility disorders, the role of gut hormones, and intestinal microflora.

Covering the Cover

Covering the Cover

Multidetector computerized tomography enema versus magnetic resonance enema in the diagnosis of rectosigmoid endometriosis

PurposeTo compare the accuracy of multidetector computerized tomography enema (MDCT-e) and magnetic resonance enema (MRI-e) in determining the presence of sigmoid and rectal endometriotic nodules. Materials and methods260 women (32.6±4.3 years) with symptoms suggestive of rectosigmoid endometriosis underwent MDCT-e and MRI-e prior to laparoscopy. After retrograde colonic distention and injection of intravenous contrast medium, patients were scanned on a 64-row MDCT scanner. MRI-e was performed on a 1.5T magnet using an 8 channels phased array coil; intestinal distention was achieved by introducing in the rectum 250–300ml of ultrasonographic gel diluted with saline solution. Radiological findings were compared with surgical and histological results. Results176 women had rectosigmoid endometriosis at surgery. There was no significant difference in the accuracy of MDCT-e (98.5%) and MRI-e (96.9%) in the diagnosis of sigmoid and rectal endometriosis (p=0.248). The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of MDCT-e and MRI-e were respectively 98.3%, 98.8%, 99.4%, 96.5%, 81.59, 0.02 and 97.2%, 96.4%, 98.3%, 94.1%, 26.89, 0.03. ConclusionsBoth MDCT-e and MRI-e are accurate in the diagnosis of rectal and sigmoid endometriosis.

Properties of submucosal venules in the rat distal colon

Venules within the gut wall may have intrinsic mechanisms for maintaining the circulation even upon the intestinal wall distension. We aimed to explore spontaneous and nerve-mediated contractile activity of colonic venules. Changes in the diameter of submucosal venules of the rat distal colon were measured using video microscopy. The innervation of the microvasculature was investigated using fluorescence immunohistochemistry. Submucosal venules exhibited spontaneous constrictions that were abolished by blockers of L-type Ca(2+) channels (1 μM nicardipine), Ca(2+)-ATPase (10 μM cyclopiazonic acid), IP3 receptor (100 μM 2-APB), Ca(2+)-activated Cl(-) channels (100 μM DIDS) or store-operated Ca(2+) entry channels (10 μM SKF96365). Transmural nerve stimulation (TNS at 10 Hz) induced a phasic venular constriction that was blocked by phentolamine (1 μM, α-adrenoceptor antagonist) or sympathetic nerve depletion using guanethidine (10 μM). Stimulation of primary afferent nerves with TNS (at 20 Hz) or capsaicin (100 nM) evoked a sustained venular dilatation that was attenuated by calcitonin gene-related peptide (CGRP) 8-37 (2 μM), a CGRP receptor antagonist. Immunohistochemistry revealed sympathetic and primary afferent nerves running along submucosal venules. Submucosal venules of the rat distal colon exhibit spontaneous constrictions that appear to primarily rely on Ca(2+) release from sarcoplasmic reticulum and subsequent opening of Ca(2+)-activated Cl(-) channels that trigger Ca(2+) influx through L-type Ca(2+) channels. Venular contractility is modulated by sympathetic as well as CGRP-containing primary afferent nerves, suggesting that submucosal venules may play an active role in regulating the microcirculation of the digestive tract.

Volvulus of an ileal pouch-rectal anastomosis after subtotal colectomy for ulcerative colitis: report of a case

Ileal J-pouch rectal anastomosis is a commonly performed procedure for patients who have undergone subtotal colectomy for ulcerative colitis or familial adenomatous polyposis without rectal involvement. We herein report the case of a patient with ileal pouch volvulus that developed 15 years after subtotal colectomy for ulcerative colitis. A 62-year-old female visited our emergency room with complaints of abdominal pain and nausea that had persisted for 12 h. Abdominal radiography and contrast-enhanced computed tomography detected segmental distention of the small intestine around the staples. We diagnosed volvulus of the ileal pouch-rectal anastomosis and performed emergency laparotomy. We released the volvulus and performed pouchpexy. The patient was discharged on postoperative day 10, and recurrence of the volvulus has not been observed for 5 months since the procedure was performed. Our study indicates that an early diagnosis and intervention are needed to avoid serious complications, such as pouch necrosis and perforation, in such cases.

Clinical usefulness of classification by transabdominal ultrasonography for detection of small-bowel stricture

Objective. To assess the clinical usefulness of transabdominal ultrasonography (TUS) for detection of small-bowel stricture. Patients and methods.Subjects were 796 patients undergoing double-balloon endoscopy (DBE), December 2003–October 2011. All underwent TUS prior to DBE. The TUS findings were classified by type as intestinal narrowing and distension at the oral side (Type A); extensive bowel wall thickening (Type B); focal bowel wall thickening (Type C) or no abnormality detected (Type D). We compared TUS findings against DBE findings with respect to small-bowel stricture, defined as failure of the enteroscope to pass through the small bowel. Results. Small-bowel stricture was detected by DBE in 11.3% (90/796) of patients. Strictures resulted from Crohn's disease (n = 36), intestinal tuberculosis (n = 24), malignant lymphoma (n = 9), ischemic enteritis (n = 6), NSAID ulcer (n = 5), radiation enteritis (n = 2), surgical anastomosis (n = 2) and other abnormalities (n = 6). Stricture was detected by TUS in 93.3% (84/90) of patients, and each such stricture fell into one of the three types of TUS abnormality. The remaining 6 strictures were detected only by DBE. DBE-identified strictures corresponded to TUS findings as follows: 100% (43/43) to Type A, 59.1% (29/49) to Type B, 14.8% (12/81) to Type C and 1% (6/623) to Type D. Correspondence between stricture and the Type A classification (vs. Types B, C and D) was significantly high, as was correspondence between stricture and Type B (vs. Types C and D). Conclusions.TUS was shown to be useful for detecting small-bowel stricture. We recommend performing TUS first when a small-bowel stricture is suspected.

A common cause of irritable bowel syndrome and diverticulitis: chronic distal colon distention from sedentary behavior and excessive dietary fiber

A multidisciplinary analysis restricted to validated reports was applied to the cause and management of irritable bowel syndrome and diverticular formation and subsequent diverticulitis. There is evidence that they are linked – both caused by attenuation of gravitational aid to distal intestinal motility, resulting in damaging chronic intestinal distention. Both irritable bowel syndrome and diverticular formation and subsequent diverticulitis have worsened in recent years owing to excessive dietary fiber intake. Potential solutions include augmenting weight-bearing time, moderating dietary fiber consumption, stimulating distal colon evacuation through chemical means and developing pharmaceuticals to block the reflexive distal colon distention associated with fiber consumption. Amplified intestinal distention commenced when all classes of Renaissance Europeans became the first group in human history to wear shoes, which led to a sedentary lifestyle that moderates gravitational aid to colon motility and evacuation.

Enteric Nervous System and Esophageal-Gastrointestinal Motility in Experimental Congenital Diaphragmatic Hernia

Gastroesophageal reflux and intestinal distension have been described in survivors of congenital diaphragmatic hernia (CDH). Deficient enteric innervation demonstrated in experimental models is a likely explanation for these symptoms. This study aimed at further characterizing these anomalies and examining esophageal and intestinal motility in this condition. Pregnant rats received either nitrofen or vehicle on E9.5. Sections of E15, E18, and E21 esophagus and small bowel were stained for protein gene product 9.5, nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase (NADPHd), and acetylcholinesterase (AChE). The proportion of neural tissue/muscle surface was measured and the NADPHd- and AChE-positive motor endplates (MEPs) were counted. E18 and E21 stomachs were stained for AChE, the ganglia were counted and measured. The peristalsis of the esophagus and small bowel was video recorded. The relative neural/muscle surface and the number of NADPHd- and AChE-positive MEPs were decreased on E15 and E18 in the esophagus and small bowel of embryos with CDH, but they tended to improve on E21. The number and the mean surface of stomach ganglia were smaller in E18 and E21 fetuses with CDH. Peristaltic movements were decreased in the esophagus and small bowel of animals with CDH. Deficient enteric innervation impaired gastrointestinal motility in experimental CDH. This could explain some long-term morbidity in the human condition.

Contrast-enhanced computed tomography of the gastrointestinal tract in clinically normal alpacas and llamas

To assess the feasibility and usefulness of CT enterography to evaluate the gastrointestinal tract in clinically normal llamas and alpacas. Prospective observational study. 7 clinically normal alpacas and 8 clinically normal llamas. The imaging protocol included orogastric administration of iodinated contrast material mixed with water. Three hours later, helical CT scanning was performed of the entire abdomen with transverse and multiplanar sagittal and dorsal projections before and after IV iodinated contrast agent injection. Both oral and IV contrast agents were well tolerated, and no adverse reactions were observed. Transverse images depicted the gastrointestinal tract and pancreas in the short axis; however, dorsal and sagittal projections aided in localizing and differentiating the various gastrointestinal segments, including the pancreas. In all camelids, the wall of the gastrointestinal tract was well differentiated. In all but 2 camelids, all gastrointestinal segments were well visualized and differentiated. In those 2 animals, the cecum was difficult to identify. Good distention of the small intestine was achieved by use of the oral contrast agent. The dorsal projections were useful to identify the pancreas in its entire length. The present study supplied new information about gastrointestinal wall thickness, intestinal diameter, and location of the pancreas and ileocecocolic junction in alpacas and llamas. Multiplanar contrast-enhanced CT was useful to reveal the various segments of the gastrointestinal tract, pancreas, and abdominal lymph nodes. The shorter time delay before imaging, compared with the delay with conventional barium studies, makes this technique complementary or superior to conventional radiographic or ultrasonographic studies for evaluation of the gastrointestinal tract.

A Case of Cecal Volvulus Presenting with Chronic Constipation in Lissencephaly

Cecal volvulus is uncommon in pediatric patients and there are few reports of cecal volvulus with cerebral palsy. Here, we report the case of a 19-year-old male patient who presented with abdominal distension, a history of cerebral palsy, refractory epilepsy due to lissencephaly, and chronic constipation. An abdominal x-ray and computed tomography without contrast enhancement showed fixed dilated bowel intensity in the right lower abdomen. Despite decompression with gastric and rectal tube insertion, symptoms did not improve. The patient underwent an exploratory laparotomy that revealed cecal volvulus. Cecal volvulus usually occurs following intestinal malrotation or previous surgery. In this patient, however, intestinal distension accompanying mental disability and chronic constipation resulted in the development of cecal volvulus. We suggest that cecal and proximal large bowel volvulus should be considered in patients presenting with progressive abdominal distension combined with a history of neuro-developmental delay and constipation.

Utilidad de la entero-resonancia magnética en el estudio de la enfermedad de Crohn pediátrica

ObjectiveTo determine the usefulness of MRI enterography for assessing the extension and activity of paediatric Crohn's disease. MRI findings were compared with clinical, biological, endoscopic and other imaging data. Patients and methodsStudies of MRI enterography use in patients younger than 18 years of age were reviewed. Patients received 500-1000mL of polyethylene glycol one hour before examination (1.5-TMR). T2 HASTE sequences with or without fat saturation, T2 true-FISP, T1 with fat saturation, pre- and post gadolinium-enhanced VIBE sequences, and dynamic and diffusion HASTE were acquired. Thickening of the bowel wall, mucosal enhancement, and extra-luminal complications were evaluated. Five MRI patterns (normal, fibrosis, mild, moderate, and severe transmural activity) were defined. Findings were compared with PCDAI scores, inflammatory parameters, and endoscopic and histological results. ResultsTwenty-two studies were reviewed. Optimal intestinal distension was present in 82% of the cases. Mild side effects were observed in 12% of patients. There was a significant relationship between MRI patterns and PCDAI scores (P=.002), sedimentation rate (P=.006) and serum PCR levels (P=.047) and a non-significant relationship with the histology (P=.571). MRI enterography correctly assessed the ileal (80%) and colonic (66%) extension. Extra-luminal complications unrelated to MRI classification (P=.274) were reported in 86.4% of studies. ConclusionsThere was a significant relationship between MRI patterns and PCR, sedimentation rate, and PCDAI scores. MRI enterography showed excellent agreement with ileoscopies, and allowed endoscopically non-accessible areas to be assessed, as well as the diagnosis of extra-luminal complications without irradiation.

Impending megacolon: small bowel distension as a predictor of toxic megacolon in ulcerative colitis

We have read with great interest the recent excellent review by Di Sabatino et al. [1] on ulcerative colitis (UC). We fully agree with their description that toxic megacolon is a life-threatening complication in severe UC, and that a standard plain X-ray study is useful to evaluate the degree of intestinal distension. In clinical settings, delay of surgery sometimes bears a poor prognosis when patients may not fulfill the clinical criteria for toxic megacolon by Jalan et al. [2] or definitive colonic dilatation. We recently experienced a case of ‘impending’ megacolon in a patient with UC, highlighting small bowel distension as a predictor of toxic megacolon. A 27-year-old man with UC presented with sudden onset of severe abdominal pain after 5 weeks’ duration of relapse with hematochezia. He had experienced multiple relapses of pancolitis and was being treated with 750 mg of oral mesalazine three times a day for over 6 years since the first presentation of colitis. On examination, the temperature was 37.6 C. Abdominal examination revealed a distended and tender abdomen with marked rebound and hypoactive bowel sounds. The clinical activity index was elevated up to 19. Laboratory tests showed an increased white blood cell count of 17,400/lL and a C-reactive protein of 8.36 mg/dL. A supine abdominal X-ray study (Fig. 1) showed a notable dilatation of the small intestine with a maximum internal diameter exceeding 4 cm (arrows) as well as indistinct colonic distension (arrowheads). He was diagnosed as having impending megacolon of UC, and therefore underwent subtotal colectomy with end ileostomy. Histopathological examination revealed severe transmural inflammation of the colon. He had an uneventful post-surgical course. Toxic megacolon, a life-threatening complication of UC and diverse colitis, is defined as nonobstructive hypotonic dilatation of the colon, classically exceeding 5.5 cm in diameter in the transverse colon on supine abdominal X-ray [3]. The pathogenesis for megacolon seems to be the excessive colonic production of inflammatory mediators that inhibit colonic motility and nitric oxide, as the key nonadrenergic, noncholinergic neurotransmitter induces colonic muscle relaxation. Recent studies indicate that the finding of persistent small bowel distension on plain abdominal radiograph characterizes a subgroup of patients at high risk for the development of toxic megacolon and multiorgan dysfunction, termed ‘impending’ megacolon [4, 5]. Gaseous distension in the uninflamed stomach and small intestine may precede colonic dilatation presumably due to the increased release of the above inflammatory mediators. The distension can result from the activation of extrinsic intestine–intestinal inhibitory reflexes, which induce paralytic ileus [5]. In conclusion, although the clinical entity of ‘impending’ megacolon has not been established yet, we highlight small bowel distension as a reliable predictor of toxic megacolon, called ‘impending’ A. Hokama (&) K. Kishimoto J. Fujita Department of Infectious, Respiratory and Digestive Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan e-mail: hokama-a@med.u-ryukyu.ac.jp

Safety evaluation of lubiprostone in the treatment of constipation and irritable bowel syndrome

Introduction: Lubiprostone is approved in the United States for the treatment of chronic idiopathic constipation and constipation predominant irritable bowel syndrome (IBS-C). Lubiprostone causes secretion of fluid and electrolytes in the small bowel, through the activation of chloride channels, and thereby induces laxation and improvement of bowel functions. It is generally considered to be safe and effective. Common side effects of lubiprostone include nausea, diarrhea, abdominal pain and bloating, and the rare side effect dyspnea. Likely mechanisms for these side effects may be related to lubiprostone's primary action on small bowel secretion and the associated intestinal distension, as well as smooth muscle contraction.Areas covered: This article reviews the pharmacokinetic and safety profile of lubiprostone, with particular relevance to the two FDA-approved dosages.Expert opinion: Lubiprostone acts topically in the gut lumen and is almost completely metabolized in the gut lumen. Lubiprostone's M3 metabolite can be detected in low concentrations in the serum and may be responsible for some of its side effects. However, the exact mechanisms by which the side effects are produced are currently unknown.

EXPERIMENTAL PRODUCTION OF NECROTIC ENTERITIS IN BROILER CHICKENS

The present study was conducted to isolate and identify the Clostridium perfringens, the etiology of necrotic enteritis (NE) from broiler chickens and experimental production of NE with this isolate. A total of 50 samples were collected from jejunum of necropsied birds for isolation and identification of Cl. perfringens. Out of 50 samples, only 4 isolates of Cl. perfringens were isolated and identified (prevalence 8%). In experimental NE, the birds of group A (orally administered with only 0.1 ml (1x103 sporulated Eimeria acervulina oocysts/bird) showed dullness, ruffled feather, vent feather soiled with bloody faeces after 1 week of coccidial challenge. The birds of group B (orally administered 1x103 sporulated Eimeria acervulina oocysts/bird and 1 ml of 2 days old broth culture of Cl. perfringens) showed severe depression, ruffled feathers, bloody faeces with fibrinous cast with 80% prevalence rate and 30% mortality in experimental NE. The birds of group C (orally inoculated with 1 ml of 2 days old broth culture of Cl. perfringens) showed no striking clinical, gross and histopathological lesions. Postmortem changes in small intestine (duodenum) were congestion and haemorrhages specially for birds of group A. The most severe gross lesions comprised of ascites, enlarged liver and heart, intestinal distension, profuse haemorrhage, fibrinous cast, fragile intestinal wall and gas bubble formation in the small intestine (duodenum, jejunum and ileum) of birds of group B. Histologically, birds of group B showed hemorrhage and congestion in liver, heart and intestine, desquamation of intestinal epithelium and intense leukocytic infiltration in intestine, liver and heart. The findings obtained from this study showed that simultaneous coccidial infection enhanced the pathological lesions of NE. DOI = http://dx.doi.org/10.3329/bjvm.v9i1.11207Bangl. J. Vet. Med. (2011). 9(1): 33–41

Right iliac fossa abscess as first manifestation of perforated adenocarcinoma of sigmoid: a rare case report

Colorectal cancer usually present with known symptoms while there are less common manifestation including abscess formation which can be intra or extra peritoneal. A 60-year-old Caucasian male with a history of RLQ abdominal pain, nausea, vomiting and anorexia from 15 days ago referred to surgery ward. Ultrasound showed a hypoachoic lesion with diameters 50 mm × 70 mm in RLQ of abdomen and a round echogenic area in right lobe of liver with diameter 15 mm. The findings were revealed an abscess located in right iliac fossa then local drainage of abscess was performed. Four days later the patient was re-admitted because of severe abdominal distention and lack of bowel movement. Laparoscopy was performed before proceeding with further examinations, due to the poor general condition of the patient. The sigmoid was adherent into the abdominal wall and mild intestinal loop distention and apple-core view was observed during operation. Cancer of sigmoid complicated by a right iliac fossa abscess was diagnosed and Hartman colestomy was undertaken. At the last follow-up examination 3 months after operation, the patient was in good health with no clinical evidence of recurrence.

Assessment of activity of Crohn’s disease of the ileum and large bowel: proposal for a new multiparameter MR enterography score

We evaluated the diagnostic accuracy of magnetic resonance enterography (MR-E) in assessing Crohn's disease (CD) activity by differentiating acute, chronic and remission stages of disease through a quantitative MR-E assessment. One hundred patients with a histological diagnosis of CD were studied with MR-E. Intestinal distension was obtained by oral administration of approximately 2 L of a polyethylene glycol solution (PEG). In all cases, the ileum and large bowel were imaged with morphological sequences (heavily T2-weighted single-shot, dual fast-field echo, balanced fast-field echo) and a postcontrast dynamic sequence (T1-weighted high-resolution isotropic volume excitation). Disease activity was assessed according to a multiparameter score (0-8) based on lesion morphology, signal intensity and contrast enhancement. MR-E findings were compared with clinical-laboratory data and disease activity indices [Crohn's Disease Activity Index (CDAI); Inflammatory Bowel Disease Questionnaire (IBDQ)]. Multiple regression analysis was performed by correlating MR-E score, CDAI and IBDQ. Frequencies were then compared using the χ (2) test. MR-E identified inactive disease in 9% of cases, chronic disease in 57% and active disease in the remaining 34%. The most frequently involved bowel segment was the terminal ileum (52%). A statistically significant correlation was found between MR-E score and CDAI (R=0.86; p<0.001) and between MR-E score and IBDQ (R=-0.83; p<0.001). The most suggestive parameter for disease activity was layered bowel-wall enhancement, a finding predominantly present in patients with increased CDAI (≥ 150) and/or local complications (χ (2)=7.13; p<0.01). MR-E is a noninvasive and diagnostic imaging modality for CD study and follow-up. The MR-E score proposed in this study proved to be useful in assessing disease severity and monitoring response to treatment.

In this issue – July 2012

In this issue – <scp>J</scp>uly 2012