Zhao XC, Xue CJ, Song H, Gao BH, Han FS, Xiao SX. Bowel inflammatory presentations on computed tomography in adult patients with severe aplastic anemia during flared inflammatory episodes. World J Clin Cases 2023; 11(3): 576-597 [PMID: 36793625 DOI: 10.12998/wjcc.v11.i3.576]
Corresponding Author of This Article
Shu-Xin Xiao, MD, Chief Physician, Department of Hematology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266000, Shandong Province, China. xsxa@sina.com
Research Domain of This Article
Hematology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xi-Chen Zhao, Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
Cheng-Jiang Xue, Department of Neurosurgery, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
Hui Song, Bin-Han Gao, Department of Radiology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
Fu-Shen Han, Department of Pneumology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
Shu-Xin Xiao, Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
Author contributions: Zhao XC and Xiao SX developed the idea; Zhao XC and Xue CJ organized the study; Zhao XC, Xue CJ, Song H, Gao BH, Han FS, and Xiao SX reviewed and consulted the CT images; Zhao XC drafted the manuscript; Xiao SX revised and approved the final manuscript; all authors have read and approved the final version of the manuscript.
Supported bythe Specialized Scientific Research Fund Projects of the Medical Group of Qingdao University, No. YLJT20201002.
Institutional review board statement: The study was reviewed and approved by the Central Hospital of Qingdao West Coast New Area Institutional Review Board (Approval No. 2022-10-08).
Informed consent statement: The requirement of written informed consent was waived by The Ethics Committee of The Central Hospital of Qingdao West Coast New Area since this was a retrospective study and no information linked to the patients’ identity was revealed in the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare that are relevant to the content of this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shu-Xin Xiao, MD, Chief Physician, Department of Hematology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266000, Shandong Province, China. xsxa@sina.com
Received: October 19, 2022 Peer-review started: October 19, 2022 First decision: November 25, 2022 Revised: December 3, 2022 Accepted: January 5, 2023 Article in press: January 5, 2023 Published online: January 26, 2023 Processing time: 99 Days and 0.8 Hours
ARTICLE HIGHLIGHTS
Research background
The gastrointestinal tract hosts the body’s most enriched lymphoid tissues and microbial community and therefore can provide sufficient activated immune cells and continuous intestine-derived antigens to influence the host hematopoietic and immune functions. The gastrointestinal tract is the most common site for infectious and inflammatory diseases. Morphological changes on computed tomography (CT) images can provide useful information that reflects the distribution, extent, and severity of the bowel inflammation and even suggests a pathogenic diagnosis.
Research motivation
Initiation and perpetuation of aplastic anemia (AA) pathogenesis has been found to be associated with gut inflammatory disorders (GIDs). GIDs have a powerful impact on hematopoietic and immune functions. Treatment of GIDs can improve hematological profile and immunological derangement.
Research objectives
To explore CT imaging presentations of gut inflammatory damage in adult patients with severe AA (SAA) and to provoke awareness of GIDs in the pathogenesis of hematological and autoimmune disorders.
Research methods
We retrospectively evaluated the abdominal CT imaging presentations of 17 hospitalized adult patients with SAA in search of the inflammatory niche when they presented with systemic inflammatory stress and exacerbated hematopoietic function.
Research results
All eligible patients with SAA had CT imaging abnormalities that suggested the presence of an impaired intestinal barrier and increased epithelial permeability. The inflammatory damages were concurrently present in the small intestine, the ileocecal region and the large intestines.
Research conclusions
All patients with SAA had CT imaging patterns that suggested the presence of active chronic inflammatory conditions and aggravated inflammatory damage during flared inflammatory episodes. In patients with aggravated cytopenia and clinical presentations suggestive of the presence of inflammatory responses, inflammatory diseases in the gastrointestinal tract should be considered, abdominal CT should be performed, and imaging signs that suggest the presence of gut inflammatory lesions should be carefully identified.
Research perspectives
Abdominal CT imaging presentations in association with hematopoietic failure and autoimmune diseases warrant extensive investigations.
