Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2021; 27(22): 3097-3108
Published online Jun 14, 2021. doi: 10.3748/wjg.v27.i22.3097
Idiopathic mesenteric phlebosclerosis associated with long-term oral intake of geniposide
Yang Wen, You-Wei Chen, Ai-Hong Meng, Ming Zhao, Song-Hua Fang, Yan-Qing Ma
Yang Wen, Song-Hua Fang, Yan-Qing Ma, Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
You-Wei Chen, Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Ai-Hong Meng, Department of Gastroenterology, Hangzhou Yuhang District Hospital of Traditional Chinese Medicine, Hangzhou 311100, Zhejiang Province, China
Ming Zhao, Department of Pathology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Author contributions: Wen Y, Chen YW and Meng AH conceptualized the study and contributed to data analysis and interpretation and manuscript preparation and revision; Zhao M provided writing assistance and proofread the article; Fang SH was involved in data interpretation; Chen YW, Zhao M, Fang SH and Ma YQ contributed to the discussion regarding the manuscript.
Supported by the Fund of Medical and Health Research Projects of Health Commission of Zhejiang Province, No. 2018KY247 and No. 2019KY035.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board at Zhejiang Provincial People's Hospital, which waived informed consent.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. Patient confidentiality was protected.
Conflict-of-interest statement: The authors declare that they have no competing interests.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Qing Ma, MD, Doctor, Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China. 704180026@qq.com
Received: February 17, 2021
Peer-review started: February 17, 2021
First decision: March 28, 2021
Revised: March 30, 2021
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: June 14, 2021
Processing time: 111 Days and 0.3 Hours
Abstract
BACKGROUND

Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease, and its etiology and risk factors remain uncertain.

AIM

To investigate the possible influence of Chinese herbal liquid containing geniposide on IMP.

METHODS

The detailed formula of herbal liquid prescriptions of all patients was studied, and the herbal ingredients were compared to identify the toxic agent as a possible etiological factor. Abdominal computed tomography (CT) and colonoscopy images were reviewed to determine the extent and severity of mesenteric phlebosclerosis and the presence of findings regarding colitis. The disease CT score was determined by the distribution of mesenteric vein calcification and colon wall thickening on CT images. The drinking index of medicinal liquor was calculated from the daily quantity and drinking years of Chinese medicinal liquor. Subsequently, Spearman’s correlation analysis was conducted to evaluate the correlation between the drinking index and the CT disease score.

RESULTS

The mean age of the 8 enrolled patients was 75.7 years and male predominance was found (all 8 patients were men). The patients had histories of 5-40 years of oral Chinese herbal liquids containing geniposide and exhibited typical imaging characteristics (e.g., threadlike calcifications along the colonic and mesenteric vessels or associated with a thickened colonic wall in CT images). Calcifications were confined to the right-side mesenteric vein in 6 of the 8 patients (75%) and involved the left-side mesenteric vein of 2 cases (25%) and the calcifications extended to the mesorectum in 1 of them. The thickening of colon wall mainly occurred in the right colon and the transverse colon. The median disease CT score was 4.88 (n = 7) and the median drinking index was 5680 (n = 7). After Spearman’s correlation analysis, the median CT score of the disease showed a significant positive correlation with the median drinking index (r = 0.842, P < 0.05).

CONCLUSION

Long-term oral intake of Chinese herbal liquid containing geniposide may play a role in the pathogenesis of IMP.

Keywords: Idiopathic mesenteric phlebosclerosis; Phlebosclerotic colitis; Chinese herbal liquid; Geniposide; Colonoscopy; Computed tomography

Core Tip: Idiopathic mesenteric phlebosclerosis (IMP) is a rare entity that appears almost exclusively in Asian populations and is characterized by calcification of the mesenteric veins and thickening of the wall of the right hemicolon. Long-term and frequent ingestion of biochemicals and toxins are thought to be associated with the disease. Herbal ingredients present in the patients were compared to identify the toxic agent as a possible etiological factor, and the positive correlation of the computed tomography disease score and drinking index was explored. Furthermore, underlying disease (e.g., diabetes, chronic nephritis, or malignancy) may be risk factors for IMP.