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Significance of Bowel Wall Thickening on Computed Tomography Scan: Higher Risk of Pathology Among African Americans Compared to Hispanics

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PURPOSE: The aims of our study were to examine the role of colonoscopy as further workup for bowel wall thickening reported on computed tomography (CT) scans and to investigate whether there were significant differences in pathology found among the racial groups in our study population. METHODS: This is a retrospective study from March 2005 and January 2007 of all patients who have undergone colonoscopy for bowel wall thickening found on CT scans of the abdomen. RESULTS: Of 94 patients with bowel wall thickening on CT scans, 7 (8%) had adenocarcinoma, 5 (5%) had large adenomas, 3 (3%) had infectious colitis, 2 (2%) ischemic colitis, 1 (1%) had inflammatory bowel disease, and 1 (1%) had a benign stricture. Bowel wall thickening on CT scan predicted clinical pathology in 34% of African Americans, as compared to 14% of Hispanics. Patients with significant pathology were more likely to have anemia and lower albumin levels. CONCLUSION: Patients with bowel wall thickening found on CT scans should be referred for colonoscopy, given that significant pathology is found in 20% of the cases. African Americans were 2.5 times more likely to have clinically significant pathology as compared to Hispanics.

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Significance of Bowel Wall Thickening on
Computed Tomography Scan: Higher Risk
of Pathology Among African Americans
Compared to Hispanics
Pikeshkumar Patel, MD; David Widjaja, MD; Steve Blum, PhD; Mariela Glandt, MD; Jagadish Akella,
MD; Sridhar Chilimuri, MD; Bhavna Balar, MD



                                                                           BWT remains unclear, particularly as an isolated find-
  Purpose: The aims of our study were to examine the role of
                                                                           ing. This clinical dilemma is more difficult when the
  colonoscopy as further workup for bowel wall thickening
                                                                           clinical indications for follow-up colonoscopy are not
  reported on computed tomography (CT) scans and to inves-
                                                                           obvious.
  tigate whether there were significant differences in pathol-
                                                                               Pathologic conditions, including inflammatory and
  ogy found among the racial groups in our study population.
                                                                           malignant processes, can cause BWT. Sometimes BWT is
  Methods: This is a retrospective study from March 2005 and               a subjective observation and can be caused by inadequate
  January 2007 of all patients who have undergone colonos-                 distention of the viscus2 or the presence of fecal matter.3
  copy for bowel wall thickening found on CT scans of the                      A recent study by Wolff et al4 recommends that colo-
  abdomen.                                                                 noscopy be performed for patients with BWT with
  Results: Of 94 patients with bowel wall thickening on CT                 abdominal pain since they found a 7.4% rate of colorec-
  scans, 7 (8%) had adenocarcinoma, 5 (5%) had large ade-                  tal adenocarcinoma. A study by Cai et al3 also found that
  nomas, 3 (3%) had infectious colitis, 2 (2%) ischemic colitis,           most of the patients with a thickened sigmoid colon or
  1 (1%) had inflammatory bowel disease, and 1 (1%) had a                  rectum on CT had an abnormality on follow-up colonos-
  benign stricture. Bowel wall thickening on CT scan predicted             copy. However, patient’s race was not reported in these
  clinical pathology in 34% of African Americans, as compared              studies. Data of BWT on CT scan according to race are
  to 14% of Hispanics. Patients with significant pathology were            important, as colorectal cancer incidence has been
  more likely to have anemia and lower albumin levels.                     reported to be 16% higher in African Americans than
                                                                           whites.5
  Conclusion: Patients with bowel wall thickening found on CT
                                                                               In an attempt to further clarify this issue and mini-
  scans should be referred for colonoscopy, given that signifi-
                                                                           mize the risks conferred by procedures, we retrospec-
  cant pathology is found in 20% of the cases. African Ameri-
                                                                           tively investigated whether the presence of BWT on CT
  cans were 2.5 times more likely to have clinically significant
                                                                           scan indicates underlying serious colonic pathology that
  pathology as compared to Hispanics.
                                                                           could be found by colonoscopy. We were also interested
  keywords: colon n colonoscopy n African Americans n                      in comparing the significance of BWT among our Afri-
  Latinos                                                                  can American and Hispanic patient populations.
  J Natl Me
								
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