Clinical Factors Associated with Abnormal Terminal Ileum Pathology

Abstract

Purpose: There is wide variation in the rate of terminal ileum (TI) intubation and biopsy during colonoscopy. The reported yield of TI biopsies also varies considerably, but there are limited data delineating which clinical factors increase the likelihood of finding abnormal TI pathology. We aimed to determine which clinical factors are associated with abnormal TI biopsies. Methods: We used a pathology database to identify patients with TI biopsies between January 2005 and May 2010 at a university hospital. Patients were excluded if they had known inflammatory bowel disease, other chronic ileal disease, or prior ileal surgery. All TI biopsies with any abnormality reported were reviewed in a blinded fashion by a pathologist. A significant abnormality was defined as chronic ileitis, graft vs host disease, evidence of viral or parasitic infection. Clinical factors were obtained from chart review and tested for an association with abnormal TI biopsy. Variables significant in univariate analysis at p <0.2 were included in a multivariate logistic regression model. Results: A total of 227 patients were included in the study, of which 28 (12%) had a clinically significant abnormal TI biopsy. Several variables were associated with a clinically significant abnormal TI biopsy on univariate analysis (Table 1). Due to a high rate of missing data, ferritin, ESR, and small bowel imaging were excluded from the subsequent multivariate logistic regression model. TI endoscopic appearance was also excluded as this is not a pre-test variable. Multivariate regression demonstrated that inpatient colonoscopy (OR 5.49, p=0.02) and serum albumin ≤ 3.5 (OR 5.75, p=0.006) were independently associated with a clinically significant abnormal TI biopsy.Table: No Caption available.Conclusion: Hypoalbuminemia and inpatient colonoscopy had the strongest association with an abnormal TI biopsy. Future prospective studies should evaluate the clinical factors identified in this study in order to identify patient subgroups that would benefit most from TI evaluation.