Published online Jun 14, 2021. doi: 10.3748/wjg.v27.i22.3097
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
Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease, and its etiology and risk factors remain uncertain.
To investigate the possible influence of Chinese herbal liquid containing geniposide on IMP.
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.
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).
Long-term oral intake of Chinese herbal liquid containing geniposide may play a role in the pathogenesis of IMP.
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.