On the pathogenesis and clinical course of mesenteric lymph node cavitation and hyposplenism in coeliac disease

Schmitz, Frank; Herzig, Karl‐Heinz; Stüber, Eckhard; Tiemann, Markus; Reinecke-Lüthge, Axel; Nitsche, R.; Fölsch, Ulrich R.

doi:10.1007/s00384-001-0361-8

Cited by 29 publications

(19 citation statements)

References 29 publications

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“…In a recent metaanalysis by Du et al,15 caseation necrosis on biopsy also had a specificity of 100% in differentiating ITB from CD with a pooled sensitivity (21%) similar to that of the necrotic lymph nodes. Necrotic abdominal lymph nodes have other causes, such as refractory celiac disease,31 and other infectious etiologies, such as Whipple disease 32. However, an appropriate clinical setting and histopathology of the lymph nodes would yield the appropriate diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis

et al. 2017

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Abdominal computed tomography (CT) can noninvasively image the entire gastrointestinal tract and assess extraintestinal features that are important in differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB). The present meta-analysis pooled the results of all studies on the role of CT abdomen in differentiating between CD and ITB. We searched PubMed and Embase for all publications in English that analyzed the features differentiating between CD and ITB on abdominal CT. The features included comb sign, necrotic lymph nodes, asymmetric bowel wall thickening, skip lesions, fibrofatty proliferation, mural stratification, ileocaecal area, long segment, and left colonic involvements. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (DOR) were calculated for all the features. Symmetric receiver operating characteristic curve was plotted for features present in >3 studies. Heterogeneity and publication bias was assessed and sensitivity analysis was performed by excluding studies that compared features on conventional abdominal CT instead of CT enterography (CTE). We included 6 studies (4 CTE, 1 conventional abdominal CT, and 1 CTE+conventional abdominal CT) involving 417 and 195 patients with CD and ITB, respectively. Necrotic lymph nodes had the highest diagnostic accuracy (sensitivity, 23%; specificity, 100%; DOR, 30.2) for ITB diagnosis, and comb sign (sensitivity, 82%; specificity, 81%; DOR, 21.5) followed by skip lesions (sensitivity, 86%; specificity, 74%; DOR, 16.5) had the highest diagnostic accuracy for CD diagnosis. On sensitivity analysis, the diagnostic accuracy of other features excluding asymmetric bowel wall thickening remained similar. Necrotic lymph nodes and comb sign on abdominal CT had the best diagnostic accuracy in differentiating CD and ITB.

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Section: Discussionmentioning

confidence: 99%

Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis

et al. 2017

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“…[117][118][119] Cavitating lesions in mesenteric lymph nodes and the lungs have also been reported in patients with CD and hyposplenism and can be associated with significant mortality, presumably due to an overwhelming infection. [120][121][122][123] The etiology of these cavitating lesions is unknown but some authors have suggested that immune complexes result in endothelial damage leading to intranodal hemorrhagic necrosis. 123,124 It is not known whether immunizations against encapsulated bacteria prevent infectious complications in CD patients with splenic dysfunction, and no firm conclusions can be drawn regarding routine immunizations in these patients.…”

Section: Splenic Dysfunctionmentioning

confidence: 99%

“…[120][121][122][123] The etiology of these cavitating lesions is unknown but some authors have suggested that immune complexes result in endothelial damage leading to intranodal hemorrhagic necrosis. 123,124 It is not known whether immunizations against encapsulated bacteria prevent infectious complications in CD patients with splenic dysfunction, and no firm conclusions can be drawn regarding routine immunizations in these patients. It seems reasonable to evaluate patients with CD for evidence of hyposplenism as manifested by characteristic blood-smear findings such as HowellJolly bodies, acanthocytes, and target cells.…”

Section: Splenic Dysfunctionmentioning

confidence: 99%

Hematologic manifestations of celiac disease

Halfdanarson¹,

Litzow²,

Murray

2006

Blood

320

281

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Celiac disease is a common systemic disorder that can have multiple hematologic manifestations. Patients with celiac disease may present to hematologists for evaluation of various hematologic problems prior to receiving a diagnosis of celiac disease. Anemia secondary to malabsorption of iron, folic acid, and/or vitamin B12 is a common complication of celiac disease and many patients have anemia at the time of diagnosis. Celiac disease may also be associated with thrombocytosis, thrombocytopenia, leukopenia, venous thromboembolism, hyposplenism, and IgA deficiency. Patients with celiac disease are at increased risk of being diagnosed with lymphoma, especially of the T-cell type. The risk is highest for enteropathy-type T-cell lymphoma (ETL) and B-cell lymphoma of the gut, but extraintestinal lymphomas can also be seen. ETL is an aggressive disease with poor prognosis, but strict adherence to a gluten-free diet may prevent its occurrence.

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“…It is even mentioned that CD can act as a protective condition against other cancers than lymphomas [9]. It is hypothesized that an extreme immune response elicited from damaged intestinal mucosa results in depletion of cellular components of lymph nodes manifesting as involution or cavitation and hyposplenism in CD patients [26]. This is evidence that immune system is persistently alert.…”

Section: Immune System Function In Cancer Predispositionmentioning

confidence: 99%

Celiac Disease and Cancer – Are There Potential Links? Is the Vigilance of Immune System in Celiac Disease a Double-edged Sword?

Čížková¹,

Červinková²

2016

IJCD

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Celiac disease (CD) is a chronic immune -mediated inflammatory intestinal disorder with prevalence about 1% of the West European population. The emergence of the disease is dependent on presence of grain storage proteins from wheat, barley, and rye (collectively called gluten) and genetic predisposition. After diagnosis is immediately deployed lifelong gluten free diet (GFD) to promote villous healing. In the case of CD -like other autoimmune disease, additional complications are observed especially if dietary compliance is poor. The most serious complications are malignancies including predominantly various types of lymphomas. On the other hand recent studies indicate lower risk of colon cancer in contrast to cutaneous malignant melanoma where the results are contradictory.

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On the pathogenesis and clinical course of mesenteric lymph node cavitation and hyposplenism in coeliac disease

Cited by 29 publications

References 29 publications

Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis

Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis

Hematologic manifestations of celiac disease

Celiac Disease and Cancer – Are There Potential Links? Is the Vigilance of Immune System in Celiac Disease a Double-edged Sword?

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