A Special Appearance of Gastric Mucosal Folds in Patient with Crohn's Disease: Bamboo-Like Appearance

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A Special Appearance of Gastric Mucosal Folds in Patient with Crohn's Disease: Bamboo-Like Appearance

Shiyang M^1,2 Irisawa A^1*, Shibukawa G¹, Yamabe A¹, Fujisawa M¹, Sato A¹, Arakawa N¹, Yoshida Y¹, Igarashi R¹, Maki T¹, Yamamoto S¹, Hoshi K¹, Utano K³ and Togashi K
¹Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
²Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, China
³Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Japan

^*Corresponding author: Atsushi Irisawa, Department of Gastroenterology, Aizu Medical Center, Fukushima medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan

Published: 04 May, 2016
Cite this article as: Shiyang M, Irisawa A, Shibukawa G, Yamabe A, Fujisawa M, Sato A, et al. A Special Appearance of Gastric Mucosal Folds in Patient with Crohn's Disease: Bamboo-Like Appearance. Ann Clin Case Rep. 2016; 1: 1009.

Case Presentation

A 27-year-old man consulted the outpatient department with intermittent upper abdominal discomfort for the prior 2 weeks. The patient had a history of anal incision for abscess without relapse. Physical examination revealed mild discomfort on palpation of the upper quadrant with no peritoneal sign. Laboratory results showed hypoproteinemia (2.7g/dL), neutrophilia (63.8%), and slightly elevated C-reactive protein (CRP; 1.59 mg/dL). Abdominal computed tomography revealed mild wall thickening in the terminal ileum. The appendix was not visualized. Gastro endoscopy was performed to rule out upper digestive tract disease. Endoscopic images taken from the proximal part of gastric body showed bamboo-like appearance (Figure 1 and 2). Colonoscopy, double-balloon endoscopy, and capsule endoscopy were performed at the same time.Ulceration of the intestine was identified in several locations (Figure 3).
The patient was diagnosed as having Crohn's disease (CD) based on the symptoms, hypoproteinemia, anal abscess, and typical intestinal ulcer. The mucosal changes involved the gastric body, duodenal (Figure 4) and intestine ileum, without colonal lesions. Biopsies revealed a nonspecific pattern of chronic active inflammation and no evidence of Helicobacter pylori infection. Prednisolone (Asahi Kasei Corp., Tokyo, Japan) 40 mg/day with granule reduction and Mesalazine (Kyorin Pharmaceutical Co. Ltd., Tokyo, Japan) 3000 mg/day were prescribed. During the months after the procedure, the symptoms completely resolved.The patient was closely followed up.

Figure 1

Figure 1
Endoscopic view of gastric body under white light showing short stripes.

Figure 2

Figure 2
Endoscopic view of gastric body under indigo dyeing clearly showing bamboo-like appearances.

Figure 3

Figure 3
Image of double-balloon endoscopy showing ulcer of terminal ileum.

Figure 4

Figure 4
Endoscopic view showing erosion and ulcers of duodenum.

Discussion

Bamboo-like appearance (BLA) or bamboo joint-like appearance (BJA) was found in CD early in 1995 by Yokota et al. [1] who reported lymphoid aggregates, severe edema in the superficial portion of the lamina propria, lymphoid ductal dilatation, lymphangioma, and the fundic gland hyperplasiaas the most common histological findings [2]. Upper-gastrointestinal endoscopic findings of CD include BLA, notch-shaped appearance, cobblestone-like appearance, multiple aphthous ulcerations, erosion, irregular-shaped ulcers, bead-like protrusions, nodular folds, granular mucous membrane, and stenosis [3]. Earlier studies have demonstrated that BLA can be detected stably in almost 68.1% (15/22) of CD patients, with specificity of 96.4% [4,5]. Consequently, BLA might be an important clue for diagnosis of CD.

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