Ileum Research Articles

Evaluation of linked-color imaging endoscopy combined with CAD EYE for the detection and characterization of right-sided colon polyps.

Effect of Intra-arterial Bemiparin Sodium on Intestinal Ischemia-Reperfusion Injury: Animal Model.

Terminal ileum Burkitt's lymphoma related ileocolic intussusception in a five-year-old child: a case report and review of literature

Rationale:Cronkhite-Canada syndrome, also known as gastrointestinal polyp pigmentation nail dystrophy/atrophy syndrome, is a rare, nongenetic disorder of unknown etiology characterized by gastrointestinal polyps and ectodermal abnormalities. Clinical manifestations commonly include abdominal pain, diarrhea, alopecia, skin hyperpigmentation, nail dystrophy, and dysgeusia. The syndrome may be associated with life-threatening complications, such as gastrointestinal bleeding, intussusception, recurrent pancreatitis, electrolyte disturbances, and hypoproteinemia.Patient concerns:This report presents a 66-year-old man admitted for recurrent abdominal pain and diarrhea. He was initially diagnosed with acute enteritis and treated empirically with antibiotics, which provided only transient relief. His symptoms recurred and progressively worsened >10 days after treatment cessation.Diagnoses:The patient had significant abdominal symptoms with ectodermal changes, and endoscopic and computed tomography computed tomography imaging of the small intestine revealed multiple polyps throughout the gastrointestinal tract (except the esophagus).Interventions:The patient was treated with glucocorticosteroids, mesalazine, proton pump inhibitors, rehydration with potassium-containing fluids, and nutritional support.Outcomes:After treatment with glucocorticoids combined with mesalazine, the abdominal pain and diarrhea improved significantly. However, due to poor compliance, the frequency of diarrhea increased to ten episodes per day after discharge. The patient was readmitted to the hospital due to a recurrence of symptoms and was treated with glucocorticoids and mesalazine. He was discharged from the hospital after his symptoms improved.Lessons:In this case, diffuse, variably sized, densely distributed, congestive polypoid changes were seen throughout the stomach, colon, rectum, and the terminal ileum. The lesions were more pronounced in the distal region of the gastric body than in the proximal region. Histopathology was suggestive of hamartomatous polyps with infiltration by eosinophils, lymphocytes, and plasma cells. Hormonal therapy has shown significant efficacy in treating this disease. Timely therapeutic intervention combined with systematic surveillance may mitigate the potential for malignant transformation and disease-related complications.

A rare co-occurrence of Crohn’s disease (CD) and familial Mediterranean fever (FMF) is a complex comorbidity with similarities in their immune pathophysiology and clinical manifestations. This case highlights the challenges in differential diagnosis and therapeutic dilemmas arising from the need to simultaneously manage two immune-mediated diseases. We report a clinical case of an Armenian man with recurrent abdominal pain, chronic diarrhea, episodes of dynamic intestinal obstruction and weight loss. His examination at the age of 39 years revealed signs of systemic inflammation, such as increased erythrocyte sedimentation rate to 62 mm/h, C-reactive protein level to 63 mg/l, and fecal calprotectin to 1039 micrograms/g. Endoscopic examination showed gastric ulcers (0.7 × 0.5 cm), an ileum stricture impenetrable with an endoscope, as well as multiple ulcers of the terminal ileum (SES-CD 9 points). The histological report concluded on chronic ulcerative ileitis with high activity. After one year, the results of molecular genetic testing showed a homozygous pathogenic variant of the MEFV c.2177TC gene (p.Val726Ala) was identified, confirming FMF with persistent activity (serum amyloid A was increased to 32.3 micrograms/ml). The patient was diagnosed with stricturing CD with severe progressive course (A2L1L4B2p) and colchicine-resistant FMF. For CD, the patient consecutively treated with adalimumab, upadacitinib, and ustekinumab with partial response and subsequent ileocecal resection. For FMF, he received colchicine without an effect and canakinumab with complete cessation of attacks. Administration of two targeted agents for two diseases was discussed, but no final decision was taken. By the time of writing this manuscript (January 2025), the patient retained the endoscopic activity of CD with no attacks FMF under treatment with ustekinumab and colchicine. In patients with Crohn’s disease, particularly those of Armenian descent, presenting with atypical abdominal pain and treatment resistance, FMF should be excluded. Molecular genetic testing for MEFV mutations should be included into the diagnostic workup, as their presence should be regarded as a CD modifying factor associated with the disease severity and complication risks. FMF-effective drugs (e. g., canakinumab) may not control CD progression, while CD-targeted therapies (adalimumab, ustekinumab) may not fully resolve FMF manifestations. The safety and efficacy of combining biologics remain unresolved. This case underscores the need for a multidisciplinary approach, development of clear criteria to assessing the activity of combined disease, and further research to optimize treatment strategies.

This report describes a term neonate with multiple gastrointestinal issues: non-hypertrophic pyloric stenosis (NHPS)-induced gastric volvulus (GV) and ileal volvulus with atresia due to an omphalomesenteric band. The patient presented with early non-bilious vomiting and abdominal distension. Radiological studies indicated GV, gastric outlet obstruction and ileal atresia. An exploratory laparotomy confirmed terminal ileal atresia with volvulus from the fibrous band and NHPS, but no GV was found during surgery. Treatment involved resecting the terminal ileum, ileocaecal valve and caecum, followed by an ileo-ascending colonic anastomosis and pyloroplasty. Recovery was satisfactory. This case highlights the importance of considering a broad differential diagnosis in neonatal intestinal obstruction and conducting a careful evaluation of radiological findings.

Stool and symptom testing in ColoREctal Evaluation for Neoplasia in Cystic Fibrosis (SCREEN-CF).

Lipomatosis of the gastrointestinal tract is a rare condition with a small number of cases. The term lipomatosis describes the focal proliferation of normal fat in soft tissues, such as the mediastinum, kidneys, pelvis, or intestine. Lipomatosis of the ileocecal valve is a rare disease with few cases described in the medical literature. It is characterized by diffuse fatty infiltration of the ileocecal valve. It is usually asymptomatic, and when symptomatic, it may present as abdominal pain, constipation, diarrhea, an occlusive condition, or bleeding; it may be a finding on radiological studies. We present a case of lipomatosis in the terminal ileum and ileocecal valve. Contrast-enhanced multidetector computed tomography (MDCT) showed fatty infiltration in the terminal ileum and ileocecal valve.

A Rare Case of High-Grade Undifferentiated Pleomorphic Sarcoma of the Terminal Ileum in a 40-Year-Old Man: Successful Outcome and Prolonged Survival After Surgical Resection and Adjuvant Chemotherapy

Introduction: Extramedullary plasmacytoma is a rare manifestation of monoclonal plasma cell disorders, typically involving the upper aerodigestive tract. Gastrointestinal involvement is uncommon, and synchronous lesions in separate GI sites are particularly rare. Case Report: A 58-year-old male was referred to the Gastroenterology department following the incidental identification of two subepithelial lesions, measuring 10 mm and 15 mm in the transverse and descending colon, respectively, during routine screening colonoscopy. A subsequent hospital-based colonoscopy confirmed these lesions and revealed additional nodular subepithelial lesions in the terminal ileum. Endoscopic biopsies were inconclusive. One colonic and one ileal lesion were removed via endoscopic mucosal resection. Histopathological and immunohistochemical analysis confirmed IgG-kappa extramedullary plasmacytomas. Further hematological evaluation revealed no cytopenias, renal dysfunction, or hypercalcemia. Skeletal survey was unremarkable, and bone marrow biopsy showed phenotypically normal plasma cells. Given the multifocal gastrointestinal involvement, systemic therapy with bortezomib, dexamethasone, and lenalidomide was initiated, and the patient was referred for autologous stem cell transplantation. Conclusion: This case involves a rare entity with an exceptionally uncommon presentation – multifocal gastrointestinal plasmacytomas – posing unique diagnostic and therapeutic challenges that require a multidisciplinary approach. Early recognition is crucial, given the risk of progression to multiple myeloma and the need for timely, effective intervention.

A single gut wall perforation in a baby is known as spontaneous intestinal perforation, and it usually happens at the terminal ileum. It is a potentially fatal illness that affects newborns who have very low birth weight and extremely low birth weight (less than 1000 g). Low birth weight and prematurity are important risk factors. This is a case study of a preterm neonatal male having neonatal respiratory distress syndrome along with respiratory distress syndrome who was born with a weight of 1.08 kg via lower-segment caesarean section. As the infant was suffering from respiratory distress syndrome, he received a physiotherapy call to manage the symptoms. The thoracic squeeze technique and Yakson technique proved very helpful for the child to recover from the condition. The whole treatment procedure was performed with proper assessment by using the Silverman-Anderson respiratory distress score scale; face, legs, activity, cry and consolability scale; and Ballard score.

This video presents a case involving complex inflammatory bowel disease (IBD) with fistulation of the terminal ileum and sigmoid colon. We aim to discuss an overview of the decision-making involved in the pre-operative, intra-operative and post-operative stages, while highlighting the benefits of utilising a robotic platform. A 29-year-old patient with Crohn's disease underwent a robotic ileo-colic resection without anastomosis and double barrel ileostomy formation. A multidisciplinary approach was taken with regard to surgical planning. Pre-operative dietician and gastroenterology input optimised nutritional status and continued biologic therapy. Involvement with radiology was key; an MRI for surgical planning was reviewed in combination with the radiologist to determine the nature of the disease. The intra-operative video discusses factors pertaining to robotic surgery, including port placement and extraction site planning. The salient intra-operative stages are highlighted, and nuances of IBD-specific robotic techniques are discussed. The importance of pre- and intra-operative factors in IBD surgery is explored; biologic and steroid use, nutritional status, exclusive enteral nutrition, consideration for fistulating disease and adapting ports to stoma and extraction sites. Post-operative surveillance is discussed, including current practice with tattooing and severity scores, in addition to ongoing research utilising artificial intelligence to improve the ability to detect recurrence. This video presents a case of an ileo-sigmoid fistula related to Crohn's disease. Optimisation strategies for the pre-operative, intra-operative and post-operative phases are discussed. The benefits of a robotic platform with respect to the challenges of IBD surgery are demonstrated.

Comprehensive analysis of heterogeneity and cell-cell interactions in Crohn's disease reveals novel location-specific insights.

Single-Cell Transcriptomic Analysis of Terminal Ileum and Peripheral Blood Identifies B Cell Maturation Antigen (BCMA) as a Therapeutic Target in IgAN

The importance of MUC6 immunohistochemistry staining in the histopathologic examination of Crohn's disease: can we enhance our diagnostic power?

Cholestatic pruritus significantly impairs quality of life in Primary Biliary Cholangitis (PBS) and is often refractory to ursodeoxycholic acid. This review explores Linerixibat, a gut-restricted ileal bile acid transporter (IBAT) inhibitor, as a targeted therapy for PBC-associated pruritus. By selectively blocking IBAT in the terminal ileum, Linerixibat reduces systemic bile acid (BA) accumulation—a key driver of itch via MAS-related G protein-coupled receptor X4 (MRGPRX4) activation on sensory neurons. Clinical trials demonstrate Linerixibat’s efficacy in lowering serum BAs and alleviating pruritus, with a safety profile characterized primarily by manageable, mechanism-driven diarrhea. Unlike IBAT inhibitors developed for paediatric cholestatic disorders (e.g., odevixibat for PFIC), Linerixibat is optimized for adult PBC. Future therapeutic strategies may involve combining Linerixibat with agents targeting BA homeostasis (e.g., dual FXR/TRG5 agonists like INT-767) or pruritus signaling (e.g., MRGPRX4 antagonists). Ongoing Phase III trials will further define its long-term role in PBC management.

Purpose: In refractory Crohn's disease, the terminal ileum is a common site requiring excision. Laparoscopic ileocecectomy is the procedure of choice and we use a single-incision laparoscopic technique (SILS). We have previously reported our experience with SILS ileocecectomy with a sizeable cohort compared to other series. This project aims to expand on our single-institutional experience and evaluate the impact of operative experience. Methods: We completed a single-institution retrospective review of patients who underwent SILS ileocecectomy for Crohn's disease from January 1, 2009 to March 31, 2024. Operative and inpatient characteristics were collected to determine complication rates. Subgroup analysis was completed comparing previously studied patients (January 1, 2009 to February 1, 2013) to our updated cohort. Results: Seventy-eight patients underwent SILS ileocecectomy for Crohn's disease and had a median age of 16.5 years (interquartile range: 15.0, 17.8). The median length of stay (LOS) was 96 hours (72, 186). The overall complication rate was 17%. On subgroup analysis, patients operated on after 2013 were older (P = .012), had a longer disease length before operating room (OR) (P = .051) and were more likely to be on anti-tumor necrosis factor therapy (P = .014). Mean operative time was significantly lower in the newer cohort (70 mins versus 85 mins, P = .007). The patients in the newer cohort had a shorter median LOS (72 hours compared to 108 hours, P = .149) and had a lower complication (13% versus 23%, P = .283) and re-operation rate (4% versus 15%, P = .159). Conclusions: SILS ileocecectomy is effective and safe in pediatric patients with Crohn's disease. As operative experience increases, we have observed a clinically significant decrease in operative time and complication rates. Level of Evidence: III, Retrospective study.

Intestinal ultrasound (IUS) is increasingly used to monitor treatment efficacy in inflammatory bowel disease (IBD) trials. However, standardized definitions for response, remission, and optimal assessment timing remain undefined.An international expert consensus meeting was held to establish IUS endpoints for clinical trials. A panel of 35 international gastroenterologists and radiologists participated in a modified Delphi process, reviewing the literature and developing consensus statements. Agreement was defined as at least 75% consensus. Consensus was reached on 150 statements across four domains: general IBD (30 statements), luminal Crohn's disease (CD) (43), perianal CD (51), and ulcerative colitis (UC) (26). For luminal CD and UC, ultrasound response was defined by: (1) a ≥ 25% reduction in bowel wall thickness (BWT) from baseline, or (2) multifactorial improvement, combining BWT reduction with ≥1 grade decrease in colour Doppler signal (CDS) or another IUS parameter. Assessments were set at weeks 4-8 for the colon and week 12 for the terminal ileum. Ultrasound remission in luminal CD was defined as: (1) BWT normalization (≤3 mm), or (2) normalization of multiple parameters, including BWT, CDS and all other IUS parameters. Similar remission criteria were proposed for UC, but the sigmoid BWT normal range (3-4 mm) remained uncertain. The bowel ultrasound score (BUSS) for CD and the Milan ultrasound criteria (MUC) for UC were supported as standardized scoring system for trials. This consensus provides standardized IUS definitions to enhance consistency in IBD trials, supporting the integration of IUS in future research.

Background and purposeTreatment-related diarrhea is a challenge for patients treated with chemo-radiotherapy (CRT) for anal cancer in a curative setting. This study aims to investigate dosimetric and clinical predictors of acute and late diarrhea for patients treated with CRT or radiotherapy (RT) alone for anal cancer. Additionally, to investigate different bowel contouring methods ability to predict diarrhea.Patient/material and methodsPatients treated with CRT or RT alone in the prospective, observational DACG-I Plan-A study (2015–2021) were included.Toxicity endpoints were acute grade ≥2 diarrhea, and late grade ≥1 diarrhea recorded at 1 year after treatment (Common Terminology Criteria of Adverse Events (CTCAE), v4.0).Bowel volumes were contoured on the planning computed tomography (CT) as bowel cavity, bowel bag, individual bowel loops, and terminal ileum. Dosimetric variables included V15Gy, V30Gy, and V45Gy for the different bowel volumes. Clinical variables included tumor size, N-stage, and chemotherapy regimen. Logistic regression was used to evaluate the association between variables and toxicity.ResultsOf the 290 patients included in this study, 116 (40%) experienced acute grade ≥2 diarrhea, and 56 of 256 (22%) had late grade ≥1 diarrhea. Patients treated with 5-FU/Capecitabine had a threefold higher risk of acute diarrhea compared to those receiving weekly Cisplatin or RT alone (p < 0.001). A trend indicating an increased risk of acute grade ≥2 diarrhea for patients with larger bowel volumes receiving radiation was observed. This was most pronounced for bowel bag V30Gy (p = 0.09); however, results from the different bowel contouring methods were similar. No parameters were predictive of late diarrhea.InterpretationNo dosimetric or clinical predictors of late diarrhea were found and only a trend was found between higher dose to bowel and risk of acute diarrhea. Treatment with 5-FU/Capecitabine showed a notable association with acute diarrhea. No contouring method was superior in predicting diarrhea.

HR19042 is a novel, orally administered, targeted-release formulation of the topically active corticosteroid budesonide, developed to release active drug within the terminal ileum and indicated to reduced estimated glomerular filtration rate loss in adults with primary immunoglobulin A nephropathy. This randomized, single-dose, open-label, six-sequence, three-treatment crossover trial aimed to explore the pharmacokinetic (PK) of HR19042 in comparison with two other budesonide targeted-release formulations among healthy Chinese subjects. Plasma budesonide concentrations were measured via liquid chromatography with tandem mass spectrometry, and PK parameters were analyzed using non-compartmental methods. Eighteen subjects successfully completed the trial. The median Tlag and Tmax of HR19042 were 1.25 and 3.50 h shorter than those of Nefecon, respectively. The Cmax of HR19042 was approximately 1.9-fold higher than that of Nefecon and 1.4-fold higher than that of Budenofalk. Based on the AUC0-t determination, the relative bioavailability (F) of HR19042 was approximately 136.93% relative to Nefecon and 129.68% relative to Budenofalk. In vitro, the dissolution of HR19042 occurred 30 min earlier than that of Nefecon in the intestinal buffer medium. In conclusion, both in vivo and in vitro findings suggest that HR19042 exhibits a faster absorption rate and higher oral bioavailability.