title: Nodular lymphoid hyperplasia: A marker of low-grade inflammation in irritable bowel syndrome?
abstract: OBJECTIVE
  To evaluate the prevalence of nodular lymphoid hyperplasia (NLH) in adult patients undergoing colonoscopy and its association with known diseases.
  
  
  METHODS
  We selected all cases showing NLH at colonoscopy in a three-year timeframe, and stratified them into symptomatic patients with irritable bowel syndrome (IBS)-type symptoms or suspected inflammatory bowel disease (IBD), and asymptomatic individuals undergoing endoscopy for colorectal cancer screening. Data collection included medical history and final diagnosis. As controls, we considered all colonoscopies performed for the aforementioned indications during the same period.
  
  
  RESULTS
  One thousand and one hundred fifty colonoscopies were selected. NLH was rare in asymptomatic individuals (only 3%), while it was significantly more prevalent in symptomatic cases (32%). Among organic conditions associated with NLH, the most frequent was IBD, followed by infections and diverticular disease. Interestingly, 31% of IBS patients presented diffuse colonic NLH. NLH cases shared some distinctive clinical features among IBS patients: they were younger, more often female, and had a higher frequency of abdominal pain, bloating, diarrhoea, unspecific inflammation, self-reported lactose intolerance and metal contact dermatitis.
  
  
  CONCLUSIONS
  About 1/3 of patients with IBS-type symptoms or suspected IBD presented diffuse colonic NLH, which could be a marker of low-grade inflammation in a conspicuous subset of IBS patients.
authors.affiliation: Anna Chiara Piscaglia, Valentina Cesario, Giovanni Calò, Maria Loredana Stefanelli, Endoscopy and Gastroenterology Unit, Depatment of Internal Medicine, State Hospital, 47893 Borgo Maggiore, Republic of San Marino.
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Piscaglia
authors.affiliation: Anna Chiara Piscaglia, Valentina Cesario, Giovanni Calò, Maria Loredana Stefanelli, Endoscopy and Gastroenterology Unit, Depatment of Internal Medicine, State Hospital, 47893 Borgo Maggiore, Republic of San Marino.
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Laterza
authors.affiliation: Anna Chiara Piscaglia, Valentina Cesario, Giovanni Calò, Maria Loredana Stefanelli, Endoscopy and Gastroenterology Unit, Depatment of Internal Medicine, State Hospital, 47893 Borgo Maggiore, Republic of San Marino.
authors.forename: Valentina
authors.initials: V
authors.lastname: Cesario
authors.affiliation: Anna Chiara Piscaglia, Valentina Cesario, Giovanni Calò, Maria Loredana Stefanelli, Endoscopy and Gastroenterology Unit, Depatment of Internal Medicine, State Hospital, 47893 Borgo Maggiore, Republic of San Marino.
authors.forename: Viviana
authors.initials: V
authors.lastname: Gerardi
authors.affiliation: Anna Chiara Piscaglia, Valentina Cesario, Giovanni Calò, Maria Loredana Stefanelli, Endoscopy and Gastroenterology Unit, Depatment of Internal Medicine, State Hospital, 47893 Borgo Maggiore, Republic of San Marino.
authors.forename: Rosario
authors.initials: R
authors.lastname: Landi
authors.affiliation: Anna Chiara Piscaglia, Valentina Cesario, Giovanni Calò, Maria Loredana Stefanelli, Endoscopy and Gastroenterology Unit, Depatment of Internal Medicine, State Hospital, 47893 Borgo Maggiore, Republic of San Marino.
authors.forename: Loris Riccardo
authors.initials: LR
authors.lastname: Lopetuso
authors.affiliation: Anna Chiara Piscaglia, Valentina Cesario, Giovanni Calò, Maria Loredana Stefanelli, Endoscopy and Gastroenterology Unit, Depatment of Internal Medicine, State Hospital, 47893 Borgo Maggiore, Republic of San Marino.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Calò
authors.affiliation: Anna Chiara Piscaglia, Valentina Cesario, Giovanni Calò, Maria Loredana Stefanelli, Endoscopy and Gastroenterology Unit, Depatment of Internal Medicine, State Hospital, 47893 Borgo Maggiore, Republic of San Marino.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Fabbretti
authors.affiliation: Anna Chiara Piscaglia, Valentina Cesario, Giovanni Calò, Maria Loredana Stefanelli, Endoscopy and Gastroenterology Unit, Depatment of Internal Medicine, State Hospital, 47893 Borgo Maggiore, Republic of San Marino.
authors.forename: Massimo
authors.initials: M
authors.lastname: Brisigotti
authors.affiliation: Anna Chiara Piscaglia, Valentina Cesario, Giovanni Calò, Maria Loredana Stefanelli, Endoscopy and Gastroenterology Unit, Depatment of Internal Medicine, State Hospital, 47893 Borgo Maggiore, Republic of San Marino.
authors.forename: Maria Loredana
authors.initials: ML
authors.lastname: Stefanelli
authors.affiliation: Anna Chiara Piscaglia, Valentina Cesario, Giovanni Calò, Maria Loredana Stefanelli, Endoscopy and Gastroenterology Unit, Depatment of Internal Medicine, State Hospital, 47893 Borgo Maggiore, Republic of San Marino.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003106:Colon / Q000473:pathology; D003113:Colonoscopy; D017449:Dermatitis, Allergic Contact / Q000453:epidemiology / Q000209:etiology; D003967:Diarrhea / Q000453:epidemiology; D005260:Female; D006801:Humans; D007249:Inflammation; D043183:Irritable Bowel Syndrome / Q000453:epidemiology* / Q000276:immunology; D007787:Lactose Intolerance / Q000453:epidemiology; D008206:Lymphatic Diseases / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology; D008297:Male; D008670:Metals / Q000009:adverse effects; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D008670:Metals
keywords: Colonoscopy; Functional gastrointestinal diseases; Inflammation; Inflammatory bowel diseases; Irritable bowel syndrome