Gastrointestinal Wall Thickness Measured with Transabdominal Ultrasonography and Its Relationship to Demographic Factors in Healthy Subjects

Abstract

Purpose: To describe the gastrointestinal (GI) wall thickness and the thickness of individual wall layers in healthy subjects using ultrasound and to determine whether demographic factors, the ultrasound transducer frequency, or a fasting state influences these measurements.

Materials and Methods: After overnight fasting, the GI wall thickness and wall layers were measured in several regions with transabdominal, high-frequency ultrasound. 122 healthy subjects aged 23 – 79 were included. All measurements were performed with both 8 and 12-MHz transducers except for the rectum measurement (4 MHz). 23 patients were given a 300 Kcal test meal and re-examined after 30 minutes.

Results: Wall thickness measurements of the GI tract with transabdominal ultrasonography are dependent on transducer frequency (p < 0.001), weight (p < 0.001) and age (p < 0.018). The thickness of individual wall layers in the ileum and the sigmoid colon was found to be dependent on both age (p = 0.007) and weight (p < 0.001). The mean wall thickness from the jejunum to the sigmoid colon ranged from 0.9 to 1.2 mm with standard deviations (SD) of 0.3 mm or less. The mean (SD) was 2.9 (0.8) mm in the gastric antrum, 1.6 (0.3) mm in the duodenum, and 2.1 (0.5) mm in the rectum. The gastric antrum was thinner and the ileum and sigmoid colon were thicker after the test meal (p < 0.05).

Conclusion: GI wall thickness depends on weight and age. Provided adequate measurement, an abnormal GI wall should be suspected if the thickness exceeds 2 mm except for in the gastric antrum, duodenum and rectum. Reference values for wall thickness can be used regardless of fasting state or probe frequency except for in the gastric antrum.

Zusammenfassung

Hintergrund: Die Wanddicke des Magen-Darm-Traktes (GI) und die Dicke der einzelnen Wandschichten wurden bei gesunden Probanden mithilfe von Ultraschall, unter Berücksichtigung von demografischen Faktoren, Ultraschallfrequenz und in zum Untersuchungszeitpunkt nüchternen Patienten untersucht.

Material und Methoden: An über Nacht nüchternen Probanden wurden Ultraschallmessungen der Magen-Darm-Wanddicke und Wandschichten in den Darmgebieten mehreren abdominalen Regionen mit transabdominalem Hochfrequenz-Ultraschall gemessen. 122 gesunde Probanden im Alter von 23 – 79 Jahren wurden eingeschlossen. Alle Messungen wurden mit einem 8 und einem 12 MHz-Schallkopf mit Ausnahme des Mastdarms (4 MHz) durchgeführt. 20 Patienten wurde eine 300 kcal Testmahlzeit gegeben und nach 30 min erneut untersucht.

Ergebnisse: Die Wanddickenmessung des GI-Traktes mit transabdominalem Ultraschall ist abhängig von Ultraschall-Frequenz (p < 0,001), Gewicht (p < 0,001) und Alter (p < 0,018). Die Dicke der einzelnen Wandschichten des Ileums und Colon sigmoideum erwies sich abhängig sowohl von Alter (p = 0,007) als auch Gewicht (p < 0,001). Die mittlere Wanddicke des Jejunums und Colon sigmoideum reichte von 0,9 – 1,2 mm mit Standardabweichungen (SD) 0,3 mm oder weniger. Im Magenantrum betrug der Mittelwert (SD) 2,9 (0,8) mm, im Zwölffingerdarm 1,6 (0,3) mm und im Rektum 2,1 (0,5) mm. Nach der Testmahlzeit (p < 0,05) war die Wand des Magenantrums dünner und die des Ileums und Sigmoids dicker.

Schlussfolgerung: Die Wanddicke im GI-Trakt ist abhängig von Gewicht und Alter. Sofern verlässliche Messungen durchgeführt werden, können eine abnormale GI-Wand vermutet werden, wenn die Wanddicke größer als 2 mm ist. Dies gilt nicht für das Antrum, Duodenum und Rektum. Mit Ausnahme des Antrums können Referenzwerte für die Wandstärke unabhängig vom nüchternen Zustand oder der Sondenfrequenz erhoben werden.

Key words

gastrointestinal tract - healthy subjects - ultrasound

• References

• 1 Aibe T, Fuji T, Okita K et al. A fundamental study of normal layer structure of the gastrointestinal wall visualized by endoscopic ultrasonography. Scand J Gastroenterol Suppl 1986; 123: 6-15
• 2 Bolondi L, Caletti G, Casanova P et al. Problems and variations in the interpretation of the ultrasound feature of the normal upper and lower GI tract wall. Scand J Gastroenterol Suppl 1986; 123: 16-26
• 3 Kimmey MB, Martin RW, Haggitt RC et al. Histologic correlates of gastrointestinal ultrasound images. Gastroenterology 1989; 96: 433-441
• 4 Odegaard S, Kimmey MB, Cheung AHS et al. High frequency endosonography of gastrointestinal arteries: potential and limitations in vitro. European journal of ultrasound 1995; 2: 313-319
• 5 Wiersema MJ, Wiersema LM. High-resolution 25-megahertz ultrasonography of the gastrointestinal wall: histologic correlates. Gastrointest Endosc 1993; 39: 499-504
• 6 Odegaard S, Kimmey MB, Martin RW et al. The effects of applied pressure on the thickness, layers, and echogenicity of gastrointestinal wall ultrasound images. Gastrointest Endosc 1992; 38: 351-356
• 7 Parente F, Maconi G, Bianchi PG. Bowel ultrasound in Crohn disease: current role and future applications. Scand J Gastroenterol 2002; 37: 871-876
• 8 Nylund K, Odegaard S, Hausken T et al. Sonography of the small intestine. World J Gastroenterol 2009; 15: 1319-1330
• 9 Nylund K, Hausken T, Gilja OH. Ultrasound and inflammatory bowel disease. Ultrasound Q 2010; 26: 3-15
• 10 Dietrich CF, Jedrzejczyk M, Ignee A. Sonographic assessment of splanchnic arteries and the bowel wall. Eur J Radiol 2007; 64: 202-212
• 11 Haber HP, Stern M. Intestinal ultrasonography in children and young adults: bowel wall thickness is age dependent. J Ultrasound Med 2000; 19: 315-321
• 12 Fleischer AC, Muhletaler CA, James Jr AE. Sonographic assessment of the bowel wall. Am J Roentgenol 1981; 136: 887-891
• 13 Huh CH, Bhutani MS, Farfan EB et al. Individual variations in mucosa and total wall thickness in the stomach and rectum assessed via endoscopic ultrasound. Physiol Meas 2003; 24: N15-N22
• 14 Njemanze PC, Njemanze J, Skelton A et al. High-frequency ultrasound imaging of the duodenum and colon in patients with symptomatic giardiasis in comparison to amebiasis and healthy subjects. J Gastroenterol Hepatol 2008; 23: e34-e42
• 15 Pallotta N, Baccini F, Corazziari E. Contrast ultrasonography of the normal small bowel. Ultrasound Med Biol 1999; 25: 1335-1340
• 16 Sandek A, Bauditz J, Swidsinski A et al. Altered intestinal function in patients with chronic heart failure. J Am Coll Cardiol 2007; 50: 1561-1569
• 17 Rapaccini GL, Aliotta A, Pompili M et al. Gastric wall thickness in normal and neoplastic subjects: a prospective study performed by abdominal ultrasound. Gastrointest Radiol 1988; 13: 197-199
• 18 Hwang JH, Kimmey MB. Assessment of the layered structure in the gastrointestinal tract. In: Odegaard S, Gilja OH, Gregersen H, (eds.) Basic and New Aspects of Gastrointestinal Ultrasonography. 1 ed. Singapore: World Scientific Publishers; 2005: 167-188
• 19 Droyvold WB, Nilsen TI, Kruger O et al. Change in height, weight and body mass index: Longitudinal data from the HUNT Study in Norway. Int J Obes 2006; 30: 935-939
• 20 Delaney F, O’Brien RT, Waller K. Ultrasound evaluation of small bowel thickness compared to weight in normal dogs. Vet Radiol Ultrasound 2003; 44: 577-580
• 21 Hertz AF. The ileo-caecal sphincter. J Physiol 1913; 47: 54-56
• 22 Heyne R, Rickes S, Bock P et al. Non-invasive evaluation of activity in inflammatory bowel disease by power Doppler sonography. Z Gastroenterol 2002; 40: 171-175
• 23 Fraquelli M, Colli A, Casazza G et al. Role of US in detection of Crohn disease: meta-analysis. Radiology 2005; 236: 95-101
• 24 Calabrese E, Petruzziello C, Onali S et al. Severity of postoperative recurrence in Crohn’s disease: correlation between endoscopic and sonographic findings. Inflamm Bowel Dis 2009; 15: 1635-1642
• 25 Castiglione F, Bucci L, Pesce G et al. Oral contrast-enhanced sonography for the diagnosis and grading of postsurgical recurrence of Crohn’s disease. Inflamm Bowel Dis 2008;
• 26 Kunihiro K, Hata J, Manabe N et al. Predicting the need for surgery in Crohn’s disease with contrast harmonic ultrasound. Scand J Gastroenterol 2007; 42: 577-585
• 27 Migaleddu V, Scanu AM, Quaia E et al. Contrast-enhanced ultrasonographic evaluation of inflammatory activity in Crohn’s disease. Gastroenterology 2009; 137: 43-52
• 28 Pallotta N, Barberani F, Hassan NA et al. Effect of infliximab on small bowel stenoses in patients with Crohn’s disease. World J Gastroenterol 2008; 14: 1885-1890
• 29 Serra C, Menozzi G, Labate AM et al. Ultrasound assessment of vascularization of the thickened terminal ileum wall in Crohn’s disease patients using a low-mechanical index real-time scanning technique with a second generation ultrasound contrast agent. Eur J Radiol 2007; 62: 114-121