Abstract
BackgroundThe implication of microscopic ileitis finding in patients referred for ileocolonoscopy for clinically suspected inflammatory bowel disease (IBD) is not well defined, and its correlation with clinical outcome has not been fully studied. The current study aims to determine the prognostic yield of biopsies in this setting, and to evaluate the correlation of microscopic ileitis with long-term clinical outcome.MethodsWe reviewed endoscopic reports of patients referred to our department for ileocolonoscopy in the years 2010–2016, as part of a diagnostic work-up for suspected IBD. Patients whose ileocolonoscopies proved normal were included, provided that terminal ileum biopsies had been performed. Accordingly, patients were divided into groups classified as normal (normal or reactive changes) and microscopic ileitis (inflammation or ileitis of any severity). Both groups were followed prospectively to determine clinical outcome.ResultsA total of 439 patients met the inclusion criteria. Sixty-four (14.6%) showed inflammation on biopsy and were included in the microscopic ileitis group. Age range and gender figures did not differ significantly between the groups. Overall follow-up period was 6.1 ± 2.3 years. Patients in the microscopic ileitis group were significantly associated with Crohn’s diagnosis during the follow-up period compared with the normal group (19% vs 2%, OR = 11.98, 95%CI = 4.48–32.01; p < 0.01). Patients with granuloma or moderate-severe ileitis on biopsy were significantly associated with Crohn’s development (100% vs 11%; P < 0.01) compared with mild or nonspecific inflammation.ConclusionThe discovery of microscopic ileitis in clinically suspected IBD is associated with increased risk of future diagnosis of Crohn’s disease.
Highlights
The implication of microscopic ileitis finding in patients referred for ileocolonoscopy for clinically suspected inflammatory bowel disease (IBD) is not well defined, and its correlation with clinical outcome has not been fully studied
Ileocolonoscopy that includes performance of terminal ileum biopsies plays an essential role in the diagnostic work-up for suspected inflammatory bowel disease (IBD)
Performance of biopsies on a colon and a terminal ileum (TI) that appear normal during endoscopy, constitutes a dilemma for practitioners, as they are willing to complete the diagnostic evaluation by integrating histological data, but they are aware of the possible low diagnostic yield as well as the risks of prolonged or complicated procedures [5]
Summary
The implication of microscopic ileitis finding in patients referred for ileocolonoscopy for clinically suspected inflammatory bowel disease (IBD) is not well defined, and its correlation with clinical outcome has not been fully studied. Ileocolonoscopy that includes performance of terminal ileum biopsies plays an essential role in the diagnostic work-up for suspected inflammatory bowel disease (IBD). It may aid in ruling out various infectious, inflammatory or functional disorders that may mimic IBD [1,2,3]. Performance of biopsies on a colon and a TI that appear normal during endoscopy, constitutes a dilemma for practitioners, as they are willing to complete the diagnostic evaluation by integrating histological data, but they are aware of the possible low diagnostic yield as well as the risks of prolonged or complicated procedures [5]. The predominant attitude in the literature is that biopsies from a normally appearing TI have a low diagnostic yield and are not routinely recommended [7, 8]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
