Clinical significance of lymphoid hyperplasia of the lower gastrointestinal tract

Lymphoid hyperplasia of the intestine has been associated with multiple diseases and symptoms. This study was undertaken to analyze the number and topographical distribution of the lymphoid follicles. A total of 302 adult consecutive patients were enrolled when they underwent elective colonoscopy. Standardized pictures from terminal ileum and colon were taken using video colonoscopes. In each picture, the number, size, and mucosal elevation of lymphoid follicles were analyzed in relation to histological and immunological findings and medical history. Lymphoid hyperplasia was found to be most extensive in the terminal ileum and cecum. Patients with untreated gastrointestinally mediated allergy (GMA) showed the highest number of lymphoid follicles per visible field in the terminal ileum (P < 0.001) and cecum (P = 0.003) vs. the control group. Patients with infectious colitis also showed a high number of lymphoid follicles per endoscopic visible field in the transverse colon (P = 0.020). The presence of lymphoid hyperplasia is a frequent finding during colonoscopy. It may indicate an enhanced immunological mucosal response to antigenic stimulation such as GMA or infection.

References

• 1 Vighi G, Marcucci F, Sensi L. et al . Allergy and the gastrointestinal system.  Clin Exp Immunol. 2008;  153 Suppl 1 3-6
• 2 Banks P M. Gastrointestinal lymphoproliferative disorders.  Histopathology. 2007;  50 42-54
• 3 Spahn T W, Kucharzik T. Modulating the intestinal immune system: the role of lymphotoxin and GALT organs.  Gut. 2004;  53 456-465
• 4 Fujimura Y, Hosobe M, Kihara T. Ultrastructural study of M cells from colonic lymphoid nodules obtained by colonoscopic biopsy.  Dig Dis Sci. 1992;  37 1089-1098
• 5 Langman J M, Rowland R. The number and distribution of lymphoid follicles in the human large intestine.  J Anat. 1986;  149 189-194
• 6 Kenney P J, Koehler R E, Shackelford G D. The clinical significance of large lymphoid follicles of the colon.  Radiology. 1982;  142 41-46
• 7 Hizawa K, Iida M, Aoyagi K, Fujishima M. The significance of colonic mucosal lymphoid hyperplasia and aphthoid ulcers in Crohn’s disease.  Clin Radiol. 1996;  51 706-708
• 8 Capitanio M A, Kirkpatrick J A. Lymphoid hyperplasia of the colon in children. Roentgen observations.  Radiology. 1970;  94 323-327
• 9 Colon A R, DiPalma J S, Leftridge C A. Intestinal lymphonodular hyperplasia of childhood: patterns of presentation.  J Clin Gastroenterol. 1991;  13 163-166
• 10 Mukhopadhyay S, Harbol T, Floyd F D, Sidhu J S. Polypoid nodular lymphoid hyperplasia of the terminal ileum.  Arch Pathol Lab Med. 2004;  128 1186-1187
• 11 Canto J, Arista J, Hernandez J. [Nodular lymphoid hyperplasia of the intestine. Clinico-pathologic characteristics in 11 cases].  Rev Invest Clin. 1990;  42 198-203
• 12 Iacono G, Ravelli A, Di Prima L. et al . Colonic lymphoid nodular hyperplasia in children: relationship to food hypersensitivity.  Clin Gastroenterol Hepatol. 2007;  5 361-366
• 13 Rubio-Tapia A, Hernandez-Calleros J, Trinidad-Hernandez S, Uscanga L. Clinical characteristics of a group of adults with nodular lymphoid hyperplasia: a single center experience.  World J Gastroenterol. 2006;  12 1945-1948
• 14 Wakefield A J, Murch S H, Anthony A. et al . Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.  Lancet. 1998;  351 637-641
• 15 Kokkonen J. Lymphonodular hyperplasia on the duodenal bulb indicates food allergy in children.  Endoscopy. 1999;  31 464-467
• 16 Kokkonen J, Karttunen T J. Lymphonodular hyperplasia on the mucosa of the lower gastrointestinal tract in children: an indication of enhanced immune response?.  J Pediatr Gastroenterol Nutr. 2002;  34 42-46
• 17 Wakefield A J, Ashwood P, Limb K, Anthony A. The significance of ileo-colonic lymphoid nodular hyperplasia in children with autistic spectrum disorder.  Eur J Gastroenterol Hepatol. 2005;  17 827-836