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Frequency, natural course and clinical significance of symptomatic terminal ileitis
Author(s) -
Kedia Saurabh,
Kurrey Lalit,
Pratap Mouli Venigalla,
Dhingra Rajan,
Srivastava Saurabh,
Pradhan Rajesh,
Sharma Raju,
Das Prasenjit,
Tiwari Veena,
Makharia Govind,
Ahuja Vineet
Publication year - 2016
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12307
Subject(s) - medicine , ileitis , course (navigation) , terminal (telecommunication) , clinical significance , telecommunications , computer science , crohn's disease , disease , physics , astronomy
Objective Treatment guidelines for managing symptomatic terminal ileitis (TI) are lacking. We followed up a cohort of symptomatic TI patients to conduct an algorithm for their management. Methods Consecutive patients with symptomatic TI from July 2007 to October 2013 were included. Symptomatic TI was defined as isolated terminal ileum ulceration (superficial or deep) and/or nodularity with abdominal symptoms. Patients were diagnosed either with intestinal tuberculosis (ITB) or Crohn's disease (CD) using standard criteria or received only symptomatic treatment according to their clinical manifestations, endoscopic, imaging and histological (specific to ITB/CD vs non‐specific) features. Based upon above findings, an algorithm was conducted to differentiate non‐specific TI from those with specific etiology (ITB/CD). Results In all, 63/898 (7.0%) patients with ulcero‐constrictive intestinal disease had TI, of which 45 (26 males and 19 females) were included. Fever, diarrhea, weight loss, deep ulcers, and ileal thickening were more frequently observed in patients with ITB or CD having specific treatments compared with those receiving symptomatic treatments. All patients with deep ulcers and those with superficial ulcer and specific histology had ITB/CD. In patients with superficial ulcers and/or nodularity and non‐specific inflammation ( n = 31), the absence of fever, diarrhea, GI bleeding or weight loss had a negative predictive value of 92% in excluding ITB/CD. Conclusions In symptomatic TI patients with superficial ulcers and a non‐specific histology, the absence of fever, diarrhea, GI bleeding or weight loss rules out the possibility of significant diagnoses like ITB/CD.