Jiro Fujimura

Ultrasonographic evaluation of the bowel wall in inflammatory bowel disease: Comparison of in vivo and in vitro studies

To assist in the evaluation of inflammatory changes of the affected bowel, we classified the transabdominal ultrasonographic findings into types A-C. We compared the in vivo and in vitro sonographic images to the histopathologic findings of resected specimens. A total of 22 bowel specimens (five normal, 12 with Crohns disease, five with ulcerative colitis) were examined sonographically with a 3.75-MHz curved and a 7.5-MHz linear array scanner; histologic examination of the same area of tissue was performed afterwards. These three examinations corresponded well to each other. Our classification scheme is useful in quantifying the severity of inflammatory changes in the affected bowel.

Development and validation of an ultrasonographic activity index of Crohn's disease.

OBJECTIVES We developed and validated an ultrasonographic index of intestinal inflammatory activity for patients with Crohns disease. METHODS Fifty-five patients with Crohns disease were examined by transabdominal ultrasonography. The pathological findings were classified into three types (A-C) on the basis of wall thickness and wall stratification. To calculate the index, we divided the intestine into eight segments, and the scores for each segment were summed to calculate the index (ultrasonographic activity index of Crohns disease) as follows: 1 point for type A lesions, [wall thickness (mm) -2] x 2 for type B lesions, and [wall thickness (mm) -2] x 4 for type C lesions. Endoscopic or barium contrast findings were also scored in a similar fashion, with the following parametric scores: 10 for cobblestoning, 5 for longitudinal ulcers, 3 for aphthoid ulcers, and 1 for chronic inflammatory changes. RESULTS A strong correlation (r2 = 0.62, P<0.01) was found between the ultrasound index and the endoscopic/radiological score, while weak correlations were found between the endoscopic/radiological score and the Crohns disease activity index or biological indices of inflammation. CONCLUSIONS Our results show that the ultrasonographic activity index of Crohns disease can be of value in the ongoing assessment and treatment of patients.

Quantitation of Duodenogastric Reflux and Antral Motility by Color Doppler Ultrasonography: Study in Healthy Volunteers and Patients with Gastric Ulcer

BACKGROUND Our objective was to develop a simple, noninvasive method for evaluating duodenogastric reflux, along with antral motility and gastric emptying of a liquid meal. METHODS Antral motility and gastric emptying were measured by ordinary ultrasonography after a meal of 400 ml consommé. Duodenogastric reflux was evaluated by means of color Doppler. In a preliminary in vitro study we demonstrated that the test meal (consommé) contained oil particles suitable as a marker for color Doppler. We then investigated duodenogastric reflux, antral motility, and gastric emptying of a liquid meal in 43 asymptomatic healthy volunteers and in 24 patients with gastric ulcer. RESULTS This approach was feasible in 65 (97.0%) of the 67 subjects studied. Duodenogastric reflux was demonstrated in 26 (61.9%) of the 42 healthy volunteers and in 20 (87.0%) of the 23 patients with gastric ulcer. The frequency of the duodenogastric reflux and the reflux index were significantly increased in patients with gastric ulcer as compared with asymptomatic healthy volunteers. Gastric emptying and the motility index of antral contractions were significantly decreased in patients with gastric ulcer as compared with asymptomatic healthy volunteers. CONCLUSIONS Ultrasonography with color Doppler is useful for evaluating abnormalities of gastroduodenal motility and can be used to understand the pathogenesis of such disorders.

Evaluation of the colorectal wall in normal subjects and patients with ulcerative colitis using an ultrasonic catheter probe

BACKGROUND Ulcerative colitis is usually evaluated by barium enema and colonoscopy, methods of imaging that are limited to the mucosal surface. Endoscopic ultrasonography (EUS) is the best modality for the evaluation of transmural changes in the bowel wall. We therefore evaluated the colorectal wall in normal control subjects and patients with ulcerative colitis using an ultrasonic catheter probe. METHODS Endoscopic ultrasound with a catheter probe was performed on 36 normal control subjects (36 examinations) and 72 patients (111 examinations) with documented ulcerative colitis. RESULTS In normal control subjects, the total wall, mucosa, submucosa, and muscularis propria were significantly thicker in the rectum than in the colon. There was no significant difference in the thickness of the colon and rectum among different age groups or between men and women. In ulcerative colitis, we classified the boundary of each layer into three patterns (smooth, irregular, and blurred) and then classified the wall into six types. In Matts grade 2 and 3 ulcerative colitis lesions, the total wall and each layer were significantly thicker than lower grade lesions and normal control subjects. For grade 1 and most of the grade 2 lesions, the boundary of each layer was smooth. In some of the grade 3 lesions, the mucosa-submucosa and submucosa-muscularis propria layer borders were abnormal. In all grade 4 cases, the mucosa-submucosa boundary was blurred. There was some correlation between the Matts grade and EUS findings except for Matts grade 3 lesions which had various EUS patterns. CONCLUSION Endoscopic ultrasound with a catheter probe is a useful modality for the transmural assessment of the colorectal wall and, when used in conjunction with the many clinical and endoscopic parameters currently available, may contribute to the diagnosis and treatment of ulcerative colitis.