Isolated terminal ileal ulcerations in asymptomatic individuals: natural course and clinical significance

Chang, Hye-Sook; Lee, Don; Kim, Jong Cheol; Song, Hebok; Lee, Hyun Ju; Chung, Eun-Ju; Kim, Tae Hyup; Park, Hyewon; Byeon, Jeong‐Sik; Yang, Suk‐Kyun; Choe, Jaewon

doi:10.1016/j.gie.2010.08.029

Cited by 78 publications

(49 citation statements)

References 13 publications

(15 reference statements)

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“…Though there are studies describing the clinical course and follow up of asymptomatic terminal ileitis 4 5 6 , data on symptomatic terminal ileal ulcers is sparse. This study was conducted with an aim to understand the etiology and clinical outcomes of ITIU detected on ileocolonoscopy in patients with gastrointestinal symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with ileal and/or ileocolonic involvement on imaging modalities, these ulcers are always of clinical significance and help in establishing the diagnosis. On the other hand, most terminal ileal ulcers detected incidentally in asymptomatic patients can be ignored 4 , but the etiology and clinical significance of these lesions in patients with abdominal symptoms have not been defined. The diagnosis of the specific cause of ileitis is important, because misdiagnosis may result in delays or errors in patient management.…”

Section: Introductionmentioning

confidence: 99%

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Symptomatic isolated terminal ileal ulcers: etiology and clinical significance

et al. 2017

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Background With an increasing number of ileal intubations, isolated terminal ileal ulcers (ITIU) are frequently found during colonoscopies. The present study aimed at studying the etiology and clinical significance of these ulcers in patients having gastrointestinal symptoms. Methods This was a prospective observational study performed on consecutive patients who underwent ileocolonoscopy for various gastrointestinal symptoms between 1 January 2014 and 31 December 2014. Clinical, endoscopic, and histological findings of patients with ITIUs were assessed to determine the etiology and they were treated accordingly. Symptom resolution was assessed within 3 – 6 months of initial diagnosis, and colonoscopy was repeated for consenting patients. Results Among 74 (4.9 %) of 1497 patients who had ITIUs on ileocolonoscopy, 41 (55.4 %) had specific etiologies on initial testing. After 3 – 6 months follow-up, definitive diagnosis was ascertained in 44 (59.5 %) patients [Crohn’s disease (CD): 19 (25.7 %), NSAID-induced ulcers: 11 (14.9 %), intestinal tuberculosis (ITB): 9 (12.2 %), and eosinophilic enteritis: 5 (6.8 %)], and 30 patients (40.5 %) had nonspecific ulcers. After treatment, symptomatic and endoscopic resolution were noted in 55/60 patients (91.7 %) and 28/36 patients (77.8 %), respectively. Of 5/60 patients who remained symptomatic, three were initially diagnosed with nonspecific ulcers and two with CD, and they were finally diagnosed with CD and ITB respectively, and treated accordingly. Conclusions In patients with gastrointestinal symptoms, more than half of the ITIUs have specific etiologies, and timely diagnosis and appropriate treatment can prevent serious complications. Nonspecific ulcers can be managed with symptomatic treatment, but need close monitoring and re-evaluation in the case of persistence of symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Symptomatic isolated terminal ileal ulcers: etiology and clinical significance

et al. 2017

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“…15 reported the significance of isolated terminal ileal ulcerations in asymptomatic individuals and showed that most of them resolved without any treatment. This is a small pilot study aimed to understand the significance of ileal or colonic ulcerations so that appropriate management decisions can be instituted.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Evaluation of Patients With Non Alarming Lower Gastrointestinal Symptoms and Colonoscopic Findings of Ileal or Colonic Ulcerations and Histopathological Evidence of Nonspecific Colitis

George¹,

Poulose²

2016

jemds

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“…[4], [5] The clinical significance of the ITILs is unclear. Goldstein et al reported that eight of 28 patients (28.6%) developed typical CD at an average interval of 3.6 years.…”

Section: Discussionmentioning

confidence: 99%

“…[1]–[3] This has led to an increased identification of patients (about 0.1–0.3%) who are not easily classified—those with Isolated ileal abnormalities, which we have coined isolated terminal ileal lesions (ITILs). [4], [5] It is likely that a proportion of these patients are suffering from a restricted form or so-called forme fruste of Crohn's disease (CD). Currently, the clinical significance of this entity is unclear.…”

Section: Introductionmentioning

confidence: 99%

The Analysis of Factors Associated with Progression of Isolated Terminal Ileal Lesions

et al. 2014

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ObjectiveTo assess the factors associated with the progression of isolated terminal ileal lesions (ITILs) at colonoscopy in Chinese patients.MethodsPatients diagnosed with ITILs were enrolled. The ileoscopy was performed by two experienced gastroenterologists every 52 weeks. A logistic regression analysis was used to elucidate the factors associated with Crohn's disease (CD) and mucosal healing. A log rank test was used to assess the differences of the cumulative proportion of CD and mucosal healing in different groups at different times.Results(1) A total of 34 patients were included and no patient had taken nonsteroidal anti-inflammatory drug in the last 6 months; eight (23.5%) patients had a clinical diagnosis of CD, 14 (41.2%) patients achieved mucosal healing, and 12 (35.3%) patients showed no significant changes in the lesions at last follow-up. (2) The logistic regression analysis showed that only abdominal pain was a factor in the ITIL disease outcomes. (3) The cumulative proportion of CD in the abdominal pain group after 3 years was statistically higher than that in the non-abdominal pain group (42.7% vs. 6.2%, χ2 = 10.129, P = 0.001). However, the cumulative proportion of mucosal healing in the non-abdominal pain group was statistically higher than that in the abdominal pain group (73.3% vs. 5.6%, χ2 = 5.225, P = 0.022). (4) The numbers of lesions observed on the initial colonoscopy exams and the initial histologic findings were not related to the ITIL disease outcomes.ConclusionsClinical symptoms may be related to ITIL disease outcomes. Patients with abdominal pain had a high likelihood of CD, whereas those without abdominal pain had a high likelihood of mucosal healing.

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Isolated terminal ileal ulcerations in asymptomatic individuals: natural course and clinical significance

Cited by 78 publications

References 13 publications

Symptomatic isolated terminal ileal ulcers: etiology and clinical significance

Symptomatic isolated terminal ileal ulcers: etiology and clinical significance

A Retrospective Evaluation of Patients With Non Alarming Lower Gastrointestinal Symptoms and Colonoscopic Findings of Ileal or Colonic Ulcerations and Histopathological Evidence of Nonspecific Colitis

The Analysis of Factors Associated with Progression of Isolated Terminal Ileal Lesions

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