The significance of colonic mucosal lymphoid hyperplasia and aphthoid ulcers in Crohn's disease.
OBJECTIVE
To access concordance between radiological severity of aphthae and the more advanced features of Crohn's disease.


METHODS
In 75 patients with an established diagnosis of Crohn's disease, we evaluated the radiological severity of colonic aphthae by meticulous double-contrast radiography. The degree of aphthae was defined as follows: AE0 = no lesions; AE1 = small nodules without barium flecks (lymphoid hyperplasia); AE2 = minute barium flecks < or = 1 mm in size with a translucent halo (umbilical or eroded lymphoid hyperplasia); AE3 = barium flecks varying from 2 mm to 5 mm in size (typical aphthoid ulcerations). We compared the degree of the lesions to the disease activity, and reviewed these sequential changes during a mean interval of 10 months.


RESULTS
AE3 lesions were more prevalent than AE1 or AE2 lesions in patients with active colitis. AE1 or AE2 lesions were found regardless of the involved bowel sites or the disease activity. Of 44 patients receiving a nutritional diet, 26 patients showed regression of the lesions although most of the patients still exhibited AE1 or AE2 lesions. In two of eight patients without the treatment, the lesions progressed.


CONCLUSIONS
In Crohn's disease, development of aphthoid ulcers is associated with disease activity; lymphoid hyperplasia may exist independently of disease activity.
Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
K
K
Hizawa
M
M
Iida
K
K
Aoyagi
M
M
Fujishima
D000293:Adolescent; D000328:Adult; D001466:Barium Sulfate; D003106:Colon / Q000000981:diagnostic imaging* / Q000473:pathology; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014456:Ulcer / Q000000981:diagnostic imaging
D001466:Barium Sulfate