Clinical Significance of Erosive or Ulcerative Lesions Isolated in Terminal Ileum

Abstract

최근 대장내시경검사 수가 증가하면서 말단 회장의 미란 또는 궤 양 병변의 발견 빈도도 늘어나고 있다. 대장내시경검사 도중 말단 회 장에서 관찰되는 이상 소견은 약 1.8-5.0% 정도로 보고되고 있다. 말단 회장의 미란이나 궤양 병변은 염증성 장질환을 비롯하여 여러 감염 질환, 류마티스 질환, 비스테로이드성 항염증제 사용, 장정결제, 회맹판의 팽대 수축 운동으로 인한 기계적 손상 등으로 인해 발생할 수 있다. 그 중 특히 크론병과 말단 회장 병변의 연관성 및 임상적 의 Background/Aims: Although terminal ileal erosive or ulcerative lesions are frequently observed on colonoscopic examination, their clinical significance are unclear. We evaluated clinical course and significance of isolated terminal ileal erosive or ulcerative lesions. Methods: We retrospectively analyzed clinical features, number, size and histologic findings of 186 patients with isolated terminal ileal erosive or ulcerative lesions on colonoscopic examination from December 2003 to February 2012. Results: The indications for colonoscopy included screening for colorectal cancer or surveillance in 122 patients (65.6%), evaluations for symptoms in 64 patients (34.4%). Of the 186 patients, 170 underwent biopsy at the terminal ileal lesions. Histologic findings were mostly non-specific chronic inflammation except two cases of Crohn’s disease, one case of cytomegalovirus ileitis, and one case of intestinal tuberculosis. Forty six patients underwent follow-up colonoscopy and the mean duration was 17.8±14.2 months (range, 1-64 months). Of those who showed non-specific ileitis (44 patients), 35 (79.5%) showed resolution of lesions without specific treatment. In the remaining 9 (20.5%) patients, lesions were continued and two patients were diagnosed as Crohn’s disease and Behcet’s ileitis, respectively. There were no significant differences in the duration of follow-up, presence of symptoms, number and size of terminal ileal lesions between the patients who resolved and not resolved. Conclusions: Most isolated terminal ileal erosive or ulcerative lesions reveal non-specific histological findings and have a propensity to resolve without treatment. However, in small portions of patients, isolated terminal ileal lesions need careful attention because it is possible to be early inflammatory bowel diseases. (Intest Res 2012;10:350-356)