PROSPECTIVE EVALUATION OF PATIENTS WITH BOWEL WALL THICKENING

Objective: Thickening of the gastrointestinal bowel wall is commonly i dentified by abdominal computed tomographic (CT) imaging, The objectiv e of this study was to prospectively determine the prevalence of subst antial pathological abnormalities in patients with bowel wall thickeni ng by computed tomography. Methods: Consecutive patients with bowel wa ll (gastric, duodenal, or colonic) thickening prospectively identified by CT underwent endoscopy of the portion of the bowel that was identi fied as abnormal. Results: Over an 18-month period, 50 patients with b owel wall thickening underwent directed endoscopic examination, Fiftee n patients of the cohort were HIV-positive. The likelihood of detectin g an abnormality by endoscopy in the entire population was 67%, Furthe rmore, for patients with endoscopic abnormalities, 42% had a specific histological diagnosis made by biopsy taken during the endoscopy, Clin ical parameters did not predict abnormal endoscopic findings for patie nts with an abnormal computed tomographic exam. Although the rate of e ndoscopic abnormalities did not significantly differ between HIV-posit ive and HIV-negative patients, specific histological findings were mor e common among the former patients, Conclusions: In patients with bowe l wall thickening identified by CT, endoscopy demonstrates abnormaliti es in the majority of cases, Endoscopy is useful in this patient popul ation because it yields accurate identification of abnormalities and a lso permits direct biopsy, Among patients with bowel wall thickening i dentified by CT, in whom a specific diagnosis is not evident, endoscop y of the relevant portion of the bowel should be strongly considered.