Pyloric Gland Metaplasia of the Ileocecal Valve: Clinicopathologic Correlates of Inflammatory Bowel Disease

Daryl Ramai,Kinesh Changela,Madhavi Reddy

doi:10.7759/cureus.1817

Abstract

Pyloric gland metaplasia of the ileocecal valve, in the setting of Crohn’s disease, is an unusual clinical entity. Though its etiology and pathogenesis remains unclear, metaplastic changes have been associated with chronic inflammation and inflammatory bowel disease. Herein, we report a case of a 23-year-old male who presented for surveillance colonoscopy after being diagnosed with Crohn's disease four years ago. Diagnostic colonoscopy revealed stenosis of the ileocecal valve as well as a 5 mm polypoid circumferential non-obstructing lesion. Excisional biopsy followed by histopathology revealed pyloric metaplasia and non-necrotizing epithelioid cell granuloma. We discuss the clinical significance of pyloric gland metaplasia of the ileocecal valve in the context of inflammatory bowel disease.

Highlights

The ileocecal valve is a sphincter that separates the small intestine from the large intestine
We present our findings following colonoscopy as well as histopathology which demonstrate the presence of mucin-secreting cells of the gastric pylorus, suggestive of pyloric metaplasia
It is widely debated whether pyloric gland metaplasia is specific to Crohn’s disease as it is rarely observed in patients with ulcerative colitis with or without “backwash” ileitis [6,7]

Summary

Introduction

The ileocecal valve is a sphincter that separates the small intestine from the large intestine. The histology of the ileocecal valve shows a change from the villous mucosa of the ileum to a more colonic mucosa, along with thickening of the muscularis mucosa. We present a case of pyloric gland metaplasia of the ileocecal valve in a patient diagnosed with Crohn’s disease. We present our findings following colonoscopy as well as histopathology which demonstrate the presence of mucin-secreting cells of the gastric pylorus, suggestive of pyloric metaplasia. The patient underwent a colonoscopy which revealed a 5 mm polypoid circumferential nonobstructing lesion seen at the ileocecal valve (Figure 1). Biopsy of the lesion followed by histopathology revealed mildly active chronic colitis, pyloric metaplasia, and non-necrotizing epithelioid cell granuloma (Figure 2). How to cite this article Ramai D, Changela K, Reddy M (November 03, 2017) Pyloric Gland Metaplasia of the Ileocecal Valve: Clinicopathologic Correlates of Inflammatory Bowel Disease.

Discussion

Conclusions

Disclosures

Shen Bo