Prospective evaluation of patients with bowel wall thickening

Thickening of the gastrointestinal bowel wall is commonly identified by abdominal computed tomographic (CT) imaging. The objective of this study was to prospectively determine the prevalence of substantial pathological abnormalities in patients with bowel wall thickening by computed tomography.

Consecutive patients with bowel wall (gastric, duodenal, or colonic) thickening prospectively identified by CT underwent endoscopy of the portion of the bowel that was identified as abnormal.

Over an 18-month period, 50 patients with bowel wall thickening underwent directed endoscopic examination. Fifteen patients of the cohort were HIV-positive. The likelihood of detecting an abnormality by endoscopy in the entire population was 67%. Furthermore, for patients with endoscopic abnormalities, 42% had a specific histological diagnosis made by biopsy taken during the endoscopy. Clinical parameters did not predict abnormal endoscopic findings for patients with an abnormal computed tomographic exam. Although the rate of endoscopic abnormalities did not significantly differ between HIV-positive and HIV-negative patients, specific histological findings were more common among the former patients.

In patients with bowel wall thickening identified by CT, endoscopy demonstrates abnormalities in the majority of cases. Endoscopy is useful in this patient population because it yields accurate identification of abnormalities and also permits direct biopsy. Among patients with bowel wall thickening identified by CT, in whom a specific diagnosis is not evident, endoscopy of the relevant portion of the bowel should be strongly considered.