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Bamboo joint-like appearance of the stomach: a stable endoscopic landmark for Crohn's disease regardless of anti-tumor necrosis factor alpha treatment.

Hashiguchi K, Takeshima F, Akazawa Y, Matsushima K, Minami H, Yamaguchi N, Shiozawa K, Ohnita K, Ichikawa T, Isomoto H, Nakao K - Med. Sci. Monit. (2014)

Bottom Line: Fifteen of 22 patients (68.1%) presented with BJA in the stomach, 13 of whom received follow-up esophagogastroduodenal endoscopy after anti-TNF α therapy.The mean CDAI and SES-CD scores significantly improved after anti-TNF α therapy (P<0.01).The findings indicate that BJA is frequently observed in the stomach of CD patients, regardless of whether the patient has active disease or is in remission, even after anti-TNF α therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.

ABSTRACT

Background: Bamboo joint-like appearance is a common yet easy-to-miss endoscopic finding in the stomach of patients with Crohn's disease (CD). Bamboo joint-like appearance (BJA) is characterized by swollen longitudinal folds transversed by erosive fissures or linear furrows. However, whether BJA is observed during the remission stage of CD and during the active stage is unclear. In particular, the relationship between the course of BJA and anti-tumor necrosis factor (TNF) α therapy has not been studied. We aimed to evaluate the course of BJA in CD patients treated with anti-TNF α therapy.

Material and methods: We examined 22 CD patients who underwent esophagogastroduodenal endoscopy before undergoing anti-TNF α treatment. We evaluated the changes in BJA, clinical activity using the CD activity index (CDAI), and endoscopic activity using the simple endoscopic score for CD (SES-CD) from 6 months to 1 year after anti-TNF α therapy.

Results: Fifteen of 22 patients (68.1%) presented with BJA in the stomach, 13 of whom received follow-up esophagogastroduodenal endoscopy after anti-TNF α therapy. The mean CDAI and SES-CD scores significantly improved after anti-TNF α therapy (P<0.01). Despite the marked improvements in clinical and endoscopic findings, the BJA of the stomach remained unchanged in all the patients.

Conclusions: The findings indicate that BJA is frequently observed in the stomach of CD patients, regardless of whether the patient has active disease or is in remission, even after anti-TNF α therapy. Thus, BJA may be a stable endoscopic landmark in CD.

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Related in: MedlinePlus

Representative endoscopic findings before and after anti-tumor necrosis factor (TNF) α therapy. Colonoscopy findings showed mucosal healing of the colon after successful anti-TNF α treatment (A, B). Nevertheless, the bamboo joint-like appearance (BJA) of the stomach remained unchanged (C, D).
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f5-medscimonit-20-1918: Representative endoscopic findings before and after anti-tumor necrosis factor (TNF) α therapy. Colonoscopy findings showed mucosal healing of the colon after successful anti-TNF α treatment (A, B). Nevertheless, the bamboo joint-like appearance (BJA) of the stomach remained unchanged (C, D).

Mentions: Notably, despite the marked improvements detected during clinical and endoscopic evaluation, the BJA of the stomach remained unchanged in all the cases (Figure 4). Representative images of the BJA before and after successful anti-TNF α treatment are shown in Figure 5. The case illustrated in Figure 5 is of a 20-year-old man with an 8-year history of CD. Before anti-TNF α treatment, he had severe abdominal pain and frequent diarrhea (3 times a day). His serum C-reactive protein (CRP) level was 11.24 mg/dL. Colonoscopy indicated extensive longitudinal ulcers throughout the entire colon. EGD showed a BJA on the lesser curvature of the gastric body and cardia. He received adalimumab therapy. One year after the initiation of adalimumab treatment, his symptoms had significantly improved – he reported having normal stools once per day and no abdominal pain. In addition, his serum CRP level had decreased to 0.03 mg/dL, and his CDAI score markedly decreased from 321.8 to 19 after adalimumab therapy. Follow-up CS showed multiple scars in his colon and no ulcers; thus, mucosal healing of the colon had been achieved. His SES-CD score also improved remarkably, from 34 to 2. Although anti-TNF α treatment was considered successful in the colon for this patient, his EGD findings of BJA in the stomach remained unchanged.


Bamboo joint-like appearance of the stomach: a stable endoscopic landmark for Crohn's disease regardless of anti-tumor necrosis factor alpha treatment.

Hashiguchi K, Takeshima F, Akazawa Y, Matsushima K, Minami H, Yamaguchi N, Shiozawa K, Ohnita K, Ichikawa T, Isomoto H, Nakao K - Med. Sci. Monit. (2014)

Representative endoscopic findings before and after anti-tumor necrosis factor (TNF) α therapy. Colonoscopy findings showed mucosal healing of the colon after successful anti-TNF α treatment (A, B). Nevertheless, the bamboo joint-like appearance (BJA) of the stomach remained unchanged (C, D).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4206479&req=5

f5-medscimonit-20-1918: Representative endoscopic findings before and after anti-tumor necrosis factor (TNF) α therapy. Colonoscopy findings showed mucosal healing of the colon after successful anti-TNF α treatment (A, B). Nevertheless, the bamboo joint-like appearance (BJA) of the stomach remained unchanged (C, D).
Mentions: Notably, despite the marked improvements detected during clinical and endoscopic evaluation, the BJA of the stomach remained unchanged in all the cases (Figure 4). Representative images of the BJA before and after successful anti-TNF α treatment are shown in Figure 5. The case illustrated in Figure 5 is of a 20-year-old man with an 8-year history of CD. Before anti-TNF α treatment, he had severe abdominal pain and frequent diarrhea (3 times a day). His serum C-reactive protein (CRP) level was 11.24 mg/dL. Colonoscopy indicated extensive longitudinal ulcers throughout the entire colon. EGD showed a BJA on the lesser curvature of the gastric body and cardia. He received adalimumab therapy. One year after the initiation of adalimumab treatment, his symptoms had significantly improved – he reported having normal stools once per day and no abdominal pain. In addition, his serum CRP level had decreased to 0.03 mg/dL, and his CDAI score markedly decreased from 321.8 to 19 after adalimumab therapy. Follow-up CS showed multiple scars in his colon and no ulcers; thus, mucosal healing of the colon had been achieved. His SES-CD score also improved remarkably, from 34 to 2. Although anti-TNF α treatment was considered successful in the colon for this patient, his EGD findings of BJA in the stomach remained unchanged.

Bottom Line: Fifteen of 22 patients (68.1%) presented with BJA in the stomach, 13 of whom received follow-up esophagogastroduodenal endoscopy after anti-TNF α therapy.The mean CDAI and SES-CD scores significantly improved after anti-TNF α therapy (P<0.01).The findings indicate that BJA is frequently observed in the stomach of CD patients, regardless of whether the patient has active disease or is in remission, even after anti-TNF α therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.

ABSTRACT

Background: Bamboo joint-like appearance is a common yet easy-to-miss endoscopic finding in the stomach of patients with Crohn's disease (CD). Bamboo joint-like appearance (BJA) is characterized by swollen longitudinal folds transversed by erosive fissures or linear furrows. However, whether BJA is observed during the remission stage of CD and during the active stage is unclear. In particular, the relationship between the course of BJA and anti-tumor necrosis factor (TNF) α therapy has not been studied. We aimed to evaluate the course of BJA in CD patients treated with anti-TNF α therapy.

Material and methods: We examined 22 CD patients who underwent esophagogastroduodenal endoscopy before undergoing anti-TNF α treatment. We evaluated the changes in BJA, clinical activity using the CD activity index (CDAI), and endoscopic activity using the simple endoscopic score for CD (SES-CD) from 6 months to 1 year after anti-TNF α therapy.

Results: Fifteen of 22 patients (68.1%) presented with BJA in the stomach, 13 of whom received follow-up esophagogastroduodenal endoscopy after anti-TNF α therapy. The mean CDAI and SES-CD scores significantly improved after anti-TNF α therapy (P<0.01). Despite the marked improvements in clinical and endoscopic findings, the BJA of the stomach remained unchanged in all the patients.

Conclusions: The findings indicate that BJA is frequently observed in the stomach of CD patients, regardless of whether the patient has active disease or is in remission, even after anti-TNF α therapy. Thus, BJA may be a stable endoscopic landmark in CD.

Show MeSH
Related in: MedlinePlus