EFSUMB Gastrointestinal Ultrasound (GIUS) Task Force Group: Celiac sprue and other rare gastrointestinal diseases ultrasound features

Abstract

Transabdominal gastrointestinal ultrasound (GIUS) is unique in its capacity to examine the bowel non-invasively and in its physiological condition, including extra-intestinal features such as the splanchnic vessels, mesentery, omentum and lymph nodes- even at the bedside. Despite this, and its extensive documentation for its usefulness, it has only been fully implemented in a few European countries and expert centres. Therefore, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) established a GIUS Task Force Group in 2014 consisting of international experts from 9 European countries with the objectives to standardize and promote the use of GIUS in a clinical setting. This is achieved by publishing clinical guidelines and recommendations on indications and use of GIUS and so far,4 guidelines have been published: first on “examination techniques and normal findings”, second on “inflammatory bowel disease”, third on “acute appendicitis and diverticulitis” and fourth on “transrectal and perineal ultrasound”.This paper describes the ultrasound features of miscellaneous disorders such as celiac disease, cystic fibrosis, omental infarction, Meckel’s diverticle, endometriosis, intestinal neoplasia, mucocele, amyloidosis, GVHD, foreign bodies, vasculitis, and pneumatosis cystoides intestinalis. Bowel ultrasound can be indicated in most of these conditions to investigate intestinal symptoms but in other cases the alterations of the bowel can be also an incidental finding that suggest other examinations which finally help to discover an unknown pathological condition.

Non-invasive prediction of persistent villous atrophy in celiac disease

“…The role of bowel ultrasound is firmly established in the diagnosis and management of Crohn’s disease[ 24 ]. Experience with bowel ultrasound in CD is rather limited; however, its use is expanding and signs corresponding with malabsorption and active CD are well defined[ 15 , 16 , 25 ]. This examination is routinely used during follow-up of CD patients in our hospital.…”

“…Using a high-frequency linear probe, it was possible to evaluate the intestinal wall, intestinal folds, surrounding mesentery, mesenteric lymph nodes, and other characteristics. The main ultrasound findings in patients with active CD were decreased numbers of jejunal folds, increased numbers of ileal folds and thickening of bowel folds, dysmotility, jejunal dilatation, and intermittent intussusception[ 15 , 16 ]. Mostly non-enlarged mesenteric lymph nodes were detected.…”

“…There might be a clinical advantage in using non-invasive methods for the detection of patients with high risks of VA, independent of improvement in symptoms after at least 1 year on GFD. Abdominal ultrasound is a widely available method, and several studies have reported specific abnormalities on small bowel imaging that could be related to CD[ 15 , 16 ]. Persistence of these findings might indicate the absence of mucosal healing.…”

Does lymph node morphology using ultrasound reflect aetiology? A pictorial essay, part I

“…[ [41][42][43] (fig 14). A diffuse increase of the LN echogenicity can be observed in Whipple's disease [44,45] (fig 15).…”

Does lymph node morphology using ultrasound reflect aetiology? A pictorial essay, part II, malignant lymphadenopathy

“…The LNs lose their architecture and may appear cystic. Similarly, tuberculosis has to be taken into account with focal lymph node lesions and necrotic tissue [10][11][12][13][14][15]. It has to be kept in mind that testicular and also ovarian lymph node metastasis may follow a similar pathway around the aorta and inferior vena cava.…”