Small bowel stenosis in Crohn’s disease: clinical, biochemical and ultrasonographic evaluation of histological features G. MACONI, L. CARSANA*, P. FOCIANI*, G. M. SAMPIETRO  , S. ARDIZZONE, M. CRISTALDI  , F. PARENTE, G. L. VAGO*, A. M. TASCHIERI  & G. BIANCHI PORRO Departments of Gastroenterology, *Pathology and  Surgery, L. Sacco University Hospital, Milan, Italy Accepted for publication 2 June 2003 SUMMARY Aim: To establish whether intestinal ultrasound, clin- ical or biochemical indices of activity can assess histological features of ileal stenosis in Crohn’s disease. Methods: In 43 patients undergoing surgery for a single ileal stenosis, clinical and biochemical parameters, as well as intestinal ultrasound, were assessed prior to surgery. The echo pattern of thickened bowel segments at the site of stenosis was classified as hypoechoic, stratified or mixed (segments with/without stratification). During surgery, stenoses were identified, resected and then histologically examined using standardized criteria. Results: Clinical and biochemical indices of activity showed an overall weak positive correlation with histological inflammatory parameters and a negative correlation with fibrosis. The intestinal ultrasound echo pattern at the stenosis site was stratified in 25 patients, hypoechoic in 14 and mixed in four. Stenoses characterized by a stratified echo pattern showed a significantly higher degree of fibrosis, those characterized by hypoechoic echo pattern showed a higher degree of inflammation, while stenoses with a mixed echo pattern showed high degrees of both fibrosis and inflammation. Conclusion: Ultrasound and, to a lesser degree, clinical and laboratory indices discriminate between inflamma- tory and fibrotic ileal stenoses complicating Crohn’s disease, thus allowing appropriate medical and/or surgical treatment to be defined. I NTRODUCTION The usefulness of clinical and biochemical indices to define the histological features of stenosis complicating Crohn’s disease has, so far, not been fully elucidated. Although Crohn’s disease activity index, erythrocyte sedimentation rate and C reactive protein are considered the most reliable clinical and laboratory means of assessing inflammatory activity, their correlation in fibrostenotic Crohn’s disease and their relationship with morphological changes of the bowel have yielded disappointing results. 1–4 Transabdominal ultrasound has proved to be of value in assessing intestinal complications of Crohn’s disease and in evaluating bowel wall changes. 5–11 Recent studies have shown that ultrasound reveals intestinal stenoses in most Crohn’s disease patients requiring surgery 7, 8, 10, 12 , and in vitro studies have demonstra- ted that the ultrasound echo pattern provides images of neoplastic and inflammatory diseases corresponding to the histological tissue structure. 13, 14 However, while ultrasound can be reliably used to detect stenosis and suggest histological features of bowel walls, the potential of ultrasound in the assessment of histological features of stenoses complicating Crohn’s disease remains to be established. The aim of the present study was to assess whether clinical and biochemical indices of activity, as well as the Correspondence to: Dr G. Maconi, Department of Gastroenterology, ‘L. Sacco’ University Hospital, Via G.B. Grassi, 74, 20157 Milano, Italy. E-mail: giovanni.maconi@unimi.it Aliment Pharmacol Ther 2003; 18: 749–756. doi: 10.1046/j.1365-2036.2003.01673.x Ó 2003 Blackwell Publishing Ltd 749