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Endoscopy 2010; 42(4): 334-337
DOI: 10.1055/s-0029-1243936
Case report/series

© Georg Thieme Verlag KG Stuttgart · New York

Clinical significance of lymphoid hyperplasia of the lower gastrointestinal tract

E.  Krauss1 , P.  Konturek1 , J.  Maiss2 , J.  Kressel1 , U.  Schulz3 , E.  G.  Hahn1 , M.  F.  Neurath1 , M.  Raithel1
  • 1Department of Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany
  • 2Gastroenterology Clinic Dr.Kerzel/PD Dr. Maiss, Forchheim, Germany
  • 3Medistat medical statistic, Kronshagen, Germany
Further Information

Publication History

submitted 21 July 2009

accepted after revision 30 October 2009

Publication Date:
22 February 2010 (online)

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Lymphoid hyperplasia of the intestine has been associated with multiple diseases and symptoms. This study was undertaken to analyze the number and topographical distribution of the lymphoid follicles. A total of 302 adult consecutive patients were enrolled when they underwent elective colonoscopy. Standardized pictures from terminal ileum and colon were taken using video colonoscopes. In each picture, the number, size, and mucosal elevation of lymphoid follicles were analyzed in relation to histological and immunological findings and medical history. Lymphoid hyperplasia was found to be most extensive in the terminal ileum and cecum. Patients with untreated gastrointestinally mediated allergy (GMA) showed the highest number of lymphoid follicles per visible field in the terminal ileum (P < 0.001) and cecum (P = 0.003) vs. the control group. Patients with infectious colitis also showed a high number of lymphoid follicles per endoscopic visible field in the transverse colon (P = 0.020). The presence of lymphoid hyperplasia is a frequent finding during colonoscopy. It may indicate an enhanced immunological mucosal response to antigenic stimulation such as GMA or infection.

References

  • 1 Vighi G, Marcucci F, Sensi L. et al . Allergy and the gastrointestinal system.  Clin Exp Immunol. 2008;  153 Suppl 1 3-6
    CrossrefPubMedGoogle Scholar
  • 2 Banks P M. Gastrointestinal lymphoproliferative disorders.  Histopathology. 2007;  50 42-54
    CrossrefPubMedGoogle Scholar
  • 3 Spahn T W, Kucharzik T. Modulating the intestinal immune system: the role of lymphotoxin and GALT organs.  Gut. 2004;  53 456-465
    CrossrefPubMedGoogle Scholar
  • 4 Fujimura Y, Hosobe M, Kihara T. Ultrastructural study of M cells from colonic lymphoid nodules obtained by colonoscopic biopsy.  Dig Dis Sci. 1992;  37 1089-1098
    CrossrefPubMedGoogle Scholar
  • 5 Langman J M, Rowland R. The number and distribution of lymphoid follicles in the human large intestine.  J Anat. 1986;  149 189-194
    PubMedGoogle Scholar
  • 6 Kenney P J, Koehler R E, Shackelford G D. The clinical significance of large lymphoid follicles of the colon.  Radiology. 1982;  142 41-46
    PubMedGoogle Scholar
  • 7 Hizawa K, Iida M, Aoyagi K, Fujishima M. The significance of colonic mucosal lymphoid hyperplasia and aphthoid ulcers in Crohn’s disease.  Clin Radiol. 1996;  51 706-708
    CrossrefPubMedGoogle Scholar
  • 8 Capitanio M A, Kirkpatrick J A. Lymphoid hyperplasia of the colon in children. Roentgen observations.  Radiology. 1970;  94 323-327
    PubMedGoogle Scholar
  • 9 Colon A R, DiPalma J S, Leftridge C A. Intestinal lymphonodular hyperplasia of childhood: patterns of presentation.  J Clin Gastroenterol. 1991;  13 163-166
    CrossrefPubMedGoogle Scholar
  • 10 Mukhopadhyay S, Harbol T, Floyd F D, Sidhu J S. Polypoid nodular lymphoid hyperplasia of the terminal ileum.  Arch Pathol Lab Med. 2004;  128 1186-1187
    PubMedGoogle Scholar
  • 11 Canto J, Arista J, Hernandez J. [Nodular lymphoid hyperplasia of the intestine. Clinico-pathologic characteristics in 11 cases].  Rev Invest Clin. 1990;  42 198-203
    PubMedGoogle Scholar
  • 12 Iacono G, Ravelli A, Di Prima L. et al . Colonic lymphoid nodular hyperplasia in children: relationship to food hypersensitivity.  Clin Gastroenterol Hepatol. 2007;  5 361-366
    CrossrefPubMedGoogle Scholar
  • 13 Rubio-Tapia A, Hernandez-Calleros J, Trinidad-Hernandez S, Uscanga L. Clinical characteristics of a group of adults with nodular lymphoid hyperplasia: a single center experience.  World J Gastroenterol. 2006;  12 1945-1948
    PubMedGoogle Scholar
  • 14 Wakefield A J, Murch S H, Anthony A. et al . Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.  Lancet. 1998;  351 637-641
    CrossrefPubMedGoogle Scholar
  • 15 Kokkonen J. Lymphonodular hyperplasia on the duodenal bulb indicates food allergy in children.  Endoscopy. 1999;  31 464-467
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Kokkonen J, Karttunen T J. Lymphonodular hyperplasia on the mucosa of the lower gastrointestinal tract in children: an indication of enhanced immune response?.  J Pediatr Gastroenterol Nutr. 2002;  34 42-46
    CrossrefPubMedGoogle Scholar
  • 17 Wakefield A J, Ashwood P, Limb K, Anthony A. The significance of ileo-colonic lymphoid nodular hyperplasia in children with autistic spectrum disorder.  Eur J Gastroenterol Hepatol. 2005;  17 827-836
    CrossrefPubMedGoogle Scholar

E. KraussMD 

Department of Medicine I
University of Erlangen-Nuremberg

Ulmenweg 18
91054 Erlangen
Germany

Fax: +49-9131-8535182

Email: ekaterina.krauss@uk-erlangen.de

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