Terminal Ileitis Research Articles

Immunoglobulin a Vasculitis in a Middle-Aged Male

Introduction: Immunoglobulin A vasculitis (IgAV), formerly Henoch—Schönlein purpura vasculitis, is a vasculitis commonly seen in children but seldomly seen in young adults, and rarely described in older patients. Classic presentation is a palpable cutaneous purpura on the lower extremities and buttocks with concomitant arthralgia. Studies have shown half of patients will present with gastrointestinal symptoms typically abdominal pain from ileus, intussusception and ischemia. Ileitis has only rarely been described as a presentation of IgAV in adults and the majority of such cases were seen in young adults. Case: 56-year-old Caucasian male with a history of hypertension and diabetes mellitus developed worsening abdominal pain for one month. Prior to his symptoms he was having daily bowel movements with no associated pain or gastrointestinal bleeding. He developed symptoms of constipation with abdominal pain and was started on polyethylene glycol and initially improved. Subsequently he developed a bilateral lower extremity purpuric rash which was diagnosed as a leukocytoclastic vasculitis and treated with oral sulfamethoxazole /trimethoprim. His rash improved, however due to worsening abdominal pain he presented to the hospital for evaluation. Upon initial examination his vital signs were unremarkable. His physical exam revealed a soft non-tender abdomen with bowel sounds present, and a resolving purpuric rash on the posterior bilateral lower extremities. Initial blood-work revealed leukocytosis of 14.5 K/cmm and acute kidney injury (AKI) with a creatinine of 2.15 mg/dL. Computed tomography with intravenous contrast showed findings suggestive of ileitis. Evaluation for multiple myeloma, cryoglobulinemia, and ANCA vasculitis was negative. Initially his kidney function improved with rehydration and his abdominal pain resolved with aggressive bowel regimen. Colonoscopy showed terminal ileitis with biopsies compatible with a vasculitic process. Given these findings and recurrent AKI renal biopsy was performed which showed IgA glomerulonephritis. He was started on high dose steroids and subsequently his kidney function improved with complete resolution of abdominal pain. Discussion: Although, classically associated with children and young adults, IgAV can present in older patients. Common symptoms of rash and arthralgia may be absent initially, however, this does not exclude IgAV. Findings of terminal ileitis, while rare, could be a sign of a vasculitis.

A Prospective Evaluation of Isolated Terminal Ileal Lesions in Symptomatic Patients: Natural History and Clinical Significance: Presidential Poster Award

Introduction: Because of the increasing number of ileal intubations, isolated terminal ileal (TI) lesions or abnormal mucosa such as terminal ileal ulcers (TIU), terminal ileal nodularity (TIN), and terminal ileal erosions (TIE) are commonly seen during colonoscopies. In this study, we aim to determine the natural history and clinical significance of isolated terminal ileal lesions in patients having gastrointestinal symptoms. Methods: This was a prospective observational cohort study performed on 117 subjects with TI lesions who underwent ileocolonoscopies from August 2016 to May 2018 for various gastrointestinal symptoms. Clinical, endoscopic, and histological findings of these subjects were noted to determine the etiology. After administration of treatment, subjects were followed up after 4-6 weeks to assess symptom resolution.1175 Figure 1 No Caption available.Results: The mean age of the subjects was 41.6±12.5 years among which 84 (72 %) were males. Out of 117 subjects, the prevalence of TIU, TIN, and TIE was noted to be 67 (57.3%), 37 (31.6%), and 10 (11.1%) respectively. A history of recent NSAIDs use was found in 6 (5.1%) subjects. Among all, the most common manifestation was abdominal pain 98 (83.7%), followed by abdominal discomfort 8 (6.8%), bleeding per rectum 6 (5.1%), melena 2 (1.7%), and chronic diarrhea 3 (2.6%) [Table]. Histopathological examination of the biopsy specimens showed evidence of normal mucosa, chronic ileitis, active ileitis, lymphoid hyperplasia, Crohn's disease, intestinal tuberculosis, eosinophilic enteritis in 16 (13.7%), 58 (50.4%), 17 (14.5%), 16 (13.6%), 7 (5.9%), 2 (1.7%), and 1 (0.85%) patients respectively. 80 (68.4%) patients had a complete symptomatic resolution at 4-6 weeks of follow up visit. Patients with partial symptomatic resolution (25.6%) or with persisted symptoms (5.9%) were planned for repeat colonoscopy to assess endoscopic resolution. Conclusion: Abdominal pain is the most common presenting manifestation of isolated terminal ileal lesions. Among all, more than half of the subjects showed evidence of acute or chronic terminal ileitis with symptomatic resolution within few weeks. Close monitoring and re-evaluation are needed in subjects with persisted symptoms.

CT Diagnosis of Terminal Ileitis with Clinical, Endoscopic, and Histologic Correlation - More Than Just IBD

CT Diagnosis of Terminal Ileitis with Clinical, Endoscopic, and Histologic Correlation - More Than Just IBD

US Molecular Imaging of Acute Ileitis: Anti-Inflammatory Treatment Response Monitored with Targeted Microbubbles in a Preclinical Model.

Purpose To evaluate whether dual-selectin-targeted US molecular imaging allows longitudinal monitoring of anti-inflammatory treatment effects in an acute terminal ileitis model in swine. Materials and Methods The Institutional Animal Care and Use Committee approved all animal studies. Fourteen swine with chemically induced acute terminal ileitis (day 0) were randomized into the following groups: (a) an anti-inflammatory treatment group (n = 8; meloxicam, 0.25 mg per kilogram of body weight; prednisone, 0.5 mg/kg) and (b) a control group (n = 6; saline). US molecular imaging was performed with a clinical US machine after intravenous injection of clinically translatable dual P- and E-selectin-targeted microbubbles (5 × 108/kg). Three inflamed bowel segments per swine were imaged at baseline, as well as on days 1, 3, and 6 after treatment initiation. At day 6, bowel segments were analyzed ex vivo for selectin expression levels by using quantitative immunofluorescence. Results After induction of inflammation, US molecular imaging signal increased at day 1 in both animal groups (P < .001). At day 3, signal in the treatment group decreased (P < .001 vs day 1), while signal in control animals did not significantly change (P = .18 vs day 1) and was higher (P = .001) compared with that in the treatment group. At day 6, signal in the treatment group further decreased and remained lower (P = .02) compared with that in the control group. Immunofluorescence confirmed significant (P ≤ .04) downregulation of both P- and E-selectin expression levels in treated versus control bowel segments. Conclusion Dual-selectin-targeted US molecular imaging allows longitudinal monitoring of anti-inflammatory treatment effects in a large-animal model of acute ileitis. This supports further clinical development of this quantitative and radiation-free technique for monitoring inflammatory bowel disease. © RSNA, 2018 Online supplemental material is available for this article.

Severe inflammatory ileitis resulting in ileal perforation in association with combination immune checkpoint blockade for metastatic malignant melanoma

Immune checkpoint inhibitors have become standard of care in metastatic malignant melanoma management. Despite superior effectiveness to chemotherapy, significant immune-related adverse events (irAE) may occur, particularly if used in combination....

Infecciones por Salmonella y Yersinia

IntroductionThe Salmonella and Yersinia strains that belong to the Enterobacteriaceae and Yersiniaceae families respectively, are major zoonotic agents. These strains include species that are causative agents of gastrointestinal and systemic infections. Salmonella infectionsSalmonella includes two species, Salmonella enterica and Salmonella bongori, of which, S. enterica most often causes infection in human beings. The disease form is associated with two different serotypes, those that are termed typhoid serotypes cause enteric or typhoid fever, and the non-typhoid serotypes cause gastrointestinal infections and can cause disseminated disease, and occasionally localised disease. Asymptomatic carriers are not rare, especially in the gallbladder. Yersinia infectionsThere are 3 species of the Yersinia strain, Yersinia pestis, Yersinia enterocolitica and Yersinia pseudotuberculosis. Y. pestis, the aetiological agent of plague has caused three major pandemics that decimated the world's population, and is a category A bioterrorism agent. Y. enterocolitica causes enterocolitis, with a higher incidence in countries with cold climates. The main complication of enteric disease is reactive polyarthritis which presents in 15% of patients, especially carriers of the antigen HLA-B27. Both Y. enterocolitica and Y. pseudotuberculosis are associated with mesenteric adenitis and terminal ileitis, which can be confused with acute appendicitis. Both species are associated with septicaemia in patients with immunosuppressive diseases, the elderly and haemosiderosis sufferers.

Does laparoscopic intracorporeal ileocolic anastomosis decreases surgical site infection rate? A propensity score-matched cohort study.

Foreshortened mesentery or thick abdominal wall constitutes a rationale for laparoscopic intracorporeal ileocolic anastomoses (ICA). The aim of this study was to compare intracorporeal to extracorporeal ICA in terms of surgical site infections in patients with Crohn's ileitis and overweight patients with right colon tumors. This was a prospective propensity score-matched cohort study enrolling consecutive patients with Crohn's terminal ileitis and overweight patients with right colon tumors undergoing elective laparoscopic right colon resection with intracorporeal or extracorporeal ICA. Propensity score matching with a 1:1 ratio was employed to compare diagnosis-matched patients for age, BMI, ASA, and previous abdominal surgery. Overall, 453 patients were enrolled: 233 intracorporeal vs. 220 extracorporeal. Propensity score matching left 195 intracorporeal and 195 extracorporeal patients comparable for age (p = 0.294), gender (p = 0.683), ASA (p = 0.545), BMI (p = 0.079), previous abdominal surgery (p = 0.348), and diagnosis (p = 0.301). Conversion rates (5.1 vs. 3.6%; p = 0.457) and intraoperative complications (1 vs. 2.1%; p = 0.45) were similar. Overall morbidity (5.1 vs. 12.8%; p = 0.008) and re-intervention rates (3.1 vs. 8.7%; p = 0.029) were significantly higher in extracorporeal patients. Anastomotic leak rates (0.5 vs. 1.5%; p = 0.623) did not differ. Incisional SSI rate was significantly higher in extracorporeal patients (p = 0.01). Laparoscopic intracorporeal ICA reduced incisional SSI rates as compared to its extracorporeal counterpart.

Acute febrile neutrophilic dermatosis in a patient with Crohn’s disease: case report and review of the literature

Crohn's disease is a chronic inflammatory bowel disease. The disease is characterized by acute exacerbations with diarrhea, abdominal pain, fever, anorexia, intestinal bleeding, and weight loss. Immune-mediated diseases that are frequently associated with Crohn's disease include arthritis, ankylosing spondylitis, sacroiliitis, episcleritis, uveitis, and skin lesions, such as erythema nodosum and pyoderma gangrenosum. The authors present the case of a 22-year-old female patient that was admitted to their hospital due to diarrhea, fever, arthralgias, and diffuse erythematous papules and plaques with vesicles and pustules affecting the patient's face, lips, arms, trunk, and legs. Six months prior to onset, the patient was diagnosed with terminal ileitis and Crohn's disease of the sigmoid colon. Treatment with mesalazine and budesonide had been introduced. In the diagnostic procedure, a skin biopsy was taken from the patient. Histology confirmed dense infiltration of neutrophilic polymorphonuclear leukocytes, or Sweet's syndrome. This condition is a rare manifestation of chronic inflammatory bowel diseases such as Crohn's disease and ulcerative colitis. This syndrome is thought to be a hypersensitivity reaction and may be associated with various inflammatory, infectious, or neoplastic diseases. The patient was treated with high doses of methylprednisolone (60 mg IV), which resulted in rapid improvement of Crohn's disease and skin lesions.

Prevalence of microscopic colitis in patients with chronic diarrhea

Microscopic colitis affects nearly 10% of the patients with chronic diarrhea which is defined as an increase in the number of daily defecation or the amount of stool lasting more than 4 weeks. The present study aims to analyze the Prevalence of Microscopic Colitis in patients who have admitted to a tertiary health center due to chronic diarrhea with unidentified etiology. This is a retrospective review of 54 patients (31 men and 23 women) with chronic diarrhea who were admitted to the gastroenterology department of the study center between July 2009 and July 2010. Data related with the patient age, patient gender, laboratory findings and histopathological alterations were obtained from hospital files. The men and women included in this study were statistically similar with respect to their mean age (36.4 ±11.1 years vs 43.1 ±18.0 years, p=0.125). The male and female patients with cheronic diarrhea had statistically similar incidences of duodenitis (8/31 vs 11/23, 25.8% vs 47.8%, p=0.097). These men and women had also statistically similar incidences of terminal ileitis (10/31 vs 8/23, 32.3% vs 34.8%, p=0.847) respectively. The male and female patients with chronic diarrhea had statistically similar incidences of non-specific colitis (19/31 vs 12/23, 61.3% vs 52.2%, p=0.499). However, non-specific colitis was significantly more frequent in patients with normal duodenum biopsy than patients with duodenitis (24/35, 68.6% vs 7/19, 36.8%; p=0.008). Microscopic colitis should be considered in differential diagnosis of middle aged and elderly women with chronic diarrhea. Although there is no general consensus about the localization and number of intestinal biopsies, a large number of biopsies should be collected, even from the colon mucosa with normal macroscopic appearance in these patients.

Isolated Acute Terminal Ileitis Without Preexisting Inflammatory Bowel Disease Rarely Progresses to Crohn's Disease.

Isolated acute terminal ileitis without chronic features of inflammation poses a diagnostic challenge. Few studies have investigated the clinical significance of this entity in patients without history of inflammatory bowel disease. We sought to elucidate the long-term prognosis of patients with isolated acute terminal ileitis, its rate of progression to Crohn's disease, and the factors associated with terminal ileitis development to Crohn's disease. Retrospective review of clinical, endoscopic, and radiographic records was performed on 108 patients with histologic evidence of isolated acute terminal ileitis on terminal ileal biopsies obtained by diagnostic ileocolonoscopy performed between January 1, 2002, and December 31, 2014, at the Mayo Clinic. Statistical analysis was performed with Student's t test and Fisher's exact test to identify the factors associated with the progression of isolated acute terminal ileitis to Crohn's disease. The median follow-up time across 108 patients was 54.7months (interquartile range 32.0-89.0months). Five patients (4.6%) developed Crohn's disease after a median of 32.3months (7.5-43.2months). The presence of narrowing/stricturing (p=0.03) on abdominal cross-sectional imaging at the time of terminal ileitis diagnosis was correlated with eventual Crohn's disease development. No significant correlation was found with clinical symptoms, endoscopic features, laboratory testing, NSAID use, smoking history, or family history of inflammatory bowel disease. Isolated acute terminal ileitis discovered on diagnostic ileocolonoscopy rarely develops to Crohn's disease. Presence of stricturing/narrowing on cross-sectional imaging may predict eventual Crohn's disease development.

Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: a randomised controlled, open-label, multicentre trial

Treatment of patients with ileocaecal Crohn's disease who have not responded to conventional therapy is commonly scaled up to biological agents, but surgery can also offer excellent short-term and long-term results. We compared laparoscopic ileocaecal resection with infliximab to assess how they affect health-related quality of life. In this randomised controlled, open-label trial, in 29 teaching hospitals and tertiary care centres in the Netherlands and the UK, adults with non-stricturing, ileocaecal Crohn's disease, in whom conventional therapy has failed were randomly allocated (1:1) by an internet randomisation module with biased-coin minimisation for participating centres and perianal fistula to receive laparoscopic ileocaecal resection or infliximab. Eligible patients were aged 18-80 years, had active Crohn's disease of the terminal ileum, and had not responded to at least 3 months of conventional therapy with glucocorticosteroids, thiopurines, or methotrexate. Patients with diseased terminal ileum longer than 40 cm or abdominal abscesses were excluded. The primary outcome was quality of life on the Inflammatory Bowel Disease Questionnaire (IBDQ) at 12 months. Secondary outcomes were general quality of life, measured by the Short Form-36 (SF-36) health survey and its physical and mental component subscales, days unable to participate in social life, days on sick leave, morbidity (additional procedures and hospital admissions), and body image and cosmesis. Analyses of the primary outcome were done in the intention-to-treat population, and safety analyses were done in the per-protocol population. This trial is registered at the Dutch Trial Registry (NTR1150). Between May 2, 2008, and October 14, 2015, 73 patients were allocated to have resection and 70 to receive infliximab. Corrected for baseline differences, the mean IBDQ score at 12 months was 178·1 (95% CI 171·1-185·0) in the resection group versus 172·0 (164·3-179·6) in the infliximab group (mean difference 6·1 points, 95% CI -4·2 to 16·4; p=0·25). At 12 months, the mean SF-36 total score was 112·1 (95% CI 108·0-116·2) in the resection group versus 106·5 (102·1-110·9) in the infliximab group (mean difference 5·6, 95% CI -0·4 to 11·6), the mean physical component score was 47·7 (45·7-49·7) versus 44·6 (42·5-46·8; mean difference 3·1, 4·2 to 6·0), and the mean mental component score was 49·5 (47·0-52·1) versus 46·1 (43·3-48·9; mean difference 3·5, -0·3 to 7·3). Mean numbers of days of sick leave were 3·4 days (SD 7·1) in the resection group versus 1·4 days (4·7) in the infliximab group (p<0·0001), days not able to take part in social life were 1·8 days (6·3) versus 1·1 days (4·5; p=0·20), days of scheduled hospital admission were 6·5 days (3·8) versus 6·8 days (3·2; p=0·84), and the number of patients who had unscheduled hospital admissions were 13 (18%) of 73 versus 15 (21%) of 70 (p=0·68). Body-image scale mean scores in the patients who had resection were 16·0 (95% CI 15·2-16·8) at baseline versus 17·8 (17·1-18·4) at 12 months, and cosmetic scale mean scores were 17·6 (16·6-18·6) versus 18·6 (17·6-19·6). Surgical intervention-related complications classified as IIIa or worse on the Clavien-Dindo scale occurred in four patients in the resection group. Treatment-related serious adverse events occurred in two patients in the infliximab group. During a median follow-up of 4 years (IQR 2-6), 26 (37%) of 70 patients in the infliximab group had resection, and 19 (26%) of 73 patients in the resection group received anti-TNF. Laparoscopic resection in patients with limited (diseased terminal ileum <40 cm), non-stricturing, ileocaecal Crohn's disease in whom conventional therapy has failed could be considered a reasonable alternative to infliximab therapy. Netherlands Organisation for Health Research and Development.

Magnetic resonance enterography with oral mannitol solution: Diagnostic efficacy and image quality in Crohn disease.

The aim of this study was to investigate the diagnostic efficacy and image quality of magnetic resonance enterography (MRE) using oral mannitol solution for the evaluation Crohn disease (CD). We retrospectively evaluated MRE examinations of 153 patients with an assumed or definitive diagnosis of CD. There were 65 men and 88 women, with a mean age of 35.7 years (range: 6-73years). MRE findings of the patients were compared to histopathologic results obtained by surgery-fiberoptic endoscopy. The sensitivity, specificity and diagnostic efficacy rate were calculated. Additionally, image quality of MRE was evaluated using a four-point scale (1=excellent, 4=poor/non-diagnostic). Sensitivity, specificity and diagnostic efficacy were 92.5%, 93% and 92.8%, respectively. Six patients had false-positive and five patients had false-negative findings. Three falsely positive patients had ulcerative colitis and three had non-specific terminal ileitis. A total of 765 small bowel segments were analyzed; 475 (62%) had an image quality score of 1 and 15 (2%), an image quality score of 4. MRE using oral mannitol solution provides excellent image quality for MRE and has high degrees of diagnostic efficacy in CD patients.

A Surprising Granulomatous Cheilitis

Question: A 17-year-old Algerian girl who had lived in France for 2 years was referred to our dermatologic unit for a painful infiltrated crusty cheilitis. She was under anti–tumor necrosis factor-α (anti-TNF-α) therapy for active Crohn disease (CD). CD was diagnosed in 2011 on rectal bleeding, weight loss and ileal ulcerations at colonoscopy. She was previously treated with 5-ASA and azathioprine without efficacy. Adalimumab was introduced in May 2015 after a pretherapeutic evaluation that included negative interferon-gamma release assay (IGRA). Dose of adalimumab was majored to 40 mg per week in December 2015 because her CD remained active. Four months later, labial lesions appeared, with edema and vesicles, and progressed to a painful infiltrated and crusty cheilitis. Antibiotics and valaciclovir treatments were unsuccessful. Oral examination revealed a unilateral cobblestone aspect with pustules on the lip mucosa without affecting the rest of oral cavity (Figure A, B). A centimetric right cervical adenopathy was noticed. She did not have any other complaints, and the rest of physical findings were normal. Laboratory results from blood chemistry, complete blood cell count, liver, and kidney analysis were within reference range. C-reactive protein was elevated (117 mg/L). Infectious workup (human immunodeficiency virus and syphilitic serology, leishmania, and herpes polymerase chain reaction) was negative. Standard chest radiography was normal. Magnetic resonance enterography revealed an asymptomatic terminal ileitis with an enhancement of the submucosa. Labial biopsies showed an epithelioid and giant cell granuloma without caseous necrosis (Figure C); Ziehl-Neelsen, Grocott and periodic acid–Schiff stains were negative for acid-fast bacilli and fungi, respectively. No viral inclusion body was seen. What is the diagnosis? Look on page 1240 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and images in GI. Initially, we suspected cutaneous metastatic Crohn’s disease. Indeed, she had severe CD resistant to a classical dose of adalimumab, and histology revealed a noncaseous granulomatous skin lesion. Negative special stains for bacteria, fungi, and parasites failed to show any microbiologic organism. New lip biopsies were performed for tuberculosis (TB) cultures, IGRA was repeated, and her treatment was intensified with infliximab and azathioprine. Two weeks later, Mycobacterium tuberculosis culture was positive on the tissue specimen. IGRA, negative before anti-TNF-α therapy, was positive. A computed tomography scan revealed nodular and micronodular opacities in superior lobes, associated with ground glass opacities. M tuberculosis was secondary found in sputum cultures. The new retained diagnosis was a TB cutis orificialis or orificial TB,1Kakisi O.K. Kechagia A.S. Kakisis I.K. et al.Tuberculosis of the oral cavity: a systematic review.Eur J Oral Sci. 2010; 118: 103-109Crossref PubMed Scopus (69) Google Scholar secondary to autoinoculation from an active pulmonary TB under anti-TNF-α therapy for a CD. After 3 weeks of anti-TB therapy and infliximab discontinuation, the lesions started to heal and showed complete resolution at the end of 6 months of treatment. Because the distinction between intestinal TB and CD is a significant source of error, colonoscopy was repeated and confirmed ileitis (Figure D). Biopsies showed a focally active ileitis with granuloma and rare giant cells without caseous necrosis. Ziehl-Neelsen staining and culture were negative after 3 months. These findings were consistent with the initial diagnosis of CD. The main cause of diagnosis error is the absence on caseous necrosis and the lack of sensibility of Ziehl stain on histologic analyses.2Wei J.-P. Wu X.-Y. Gao S.-Y. et al.Misdiagnosis and mistherapy of Crohn’s disease as intestinal tuberculosis: case report and literature review.Medicine (Baltimore). 2016; 95: e2436Crossref PubMed Scopus (11) Google Scholar TB in a context of anti-TNF-α therapy is difficult to diagnose with few symptoms, extrapulmonary presentations, and a potentially severity with a rapid evolution. This observation suggests a repeated screening for TB during the follow-up of these patients, all the more if other risk factors are associated, namely, concomitant immunosuppressant use, a history of latent or active TB, birth or travel in endemic region of TB, and/or exposure to a person with TB.3Shim T.S. Diagnosis and treatment of latent tuberculosis infection in patients with inflammatory bowel diseases due to initiation of anti-tumor necrosis factor therapy.Intest Res. 2014; 12: 12-19Crossref PubMed Google Scholar

Can ultrasound be used as the primary imaging in children with suspected Crohn disease?

There is growing literature on the use of ultrasound (US) for evaluation of Crohn disease in adults, but few studies have been conducted on children. Several studies demonstrated high accuracy of US in the diagnosis of Crohn disease. Using US as the primary screening imaging modality for Crohn disease can reduce health care costs, the need for sedation and ionizing radiation exposure. The aim of our study is to determine if US can be used for screening evaluation of pediatric Crohn disease. A prospective cohort study of pediatric patients undergoing MR enterography (MRE) for suspected or known history of Crohn disease was performed, with gray-scale and Doppler US of the terminal ileum done immediately before or after MRE. US images were interpreted by two radiologists (Reader 1 and Reader 2) not involved in image acquisition, in blinded and randomized fashion. US findings of Crohn disease including bowel wall thickening, wall stratification, increased vascularity on Doppler, lymphadenopathy, fat infiltration and extraintestinal complications were evaluated. MRE findings of terminal ileitis were considered the reference standard. Demographic data, body mass index (BMI), symptoms, and laboratory, endoscopic and histopathological data were obtained from electronic medical records. Forty-one patients (mean age: 13.7 years: 4.6-18.9 years) were evaluated. Mean BMI was 21.2 (range: 13-40.2); 10 patients (24.3%) were either overweight or obese. Final diagnoses were Crohn disease (n=24), ulcerative colitis (n=4) and normal/non-inflammatory bowel disease-related diagnoses (n=13). US demonstrated sensitivity of 67% and 78% and specificity of 78% and 83%, by Reader 1 and Reader 2, respectively. MRE sensitivity and specificity were 75% and 100%, respectively, compared to final clinicopathological diagnosis. Interobserver agreement between Reader 1 and Reader 2 was good (0.6< kappa <0.8). In screening for Crohn disease in children, US has limited sensitivity for detecting terminal ileitis.

Unexpected findings after surgery for suspected appendicitis rarely change treatment in pediatric patients; Results from a cohort study

BackgroundTo determine if non-operative treatment is safe in children with acute appendicitis, we evaluated the incidence of unexpected findings after an appendectomy in children, and the influence they have on subsequent treatment. MethodsA historical cohort study (January 2004–December 2014) was performed including children, aged 0–17 years, who underwent an appendectomy for the suspicion of acute appendicitis. Patients were divided based upon histopathological examination. Unexpected findings were reviewed, as well as the subsequent treatment plan. ResultsIn total 484 patients were included in this study. In the overall group, unexpected findings were noted in 10 (2.1%) patients of which two patients intra-operatively with a non-inflamed appendix (Ileitis terminalis N=1 and ovarian torsion N=1) and in 8 patients on histopathological examination. The latter group consisted of 4 patients with concomitant simple appendicitis (parasitic infection N=3 and Walthard cell rest N=1), two with concomitant complex appendicitis (carcinoid N=1 and parasitic infection N=1) and two patients with a non-inflamed appendix (endometriosis N=1 and parasitic infection N=1). Treatment was changed in 4 patients (<1%). ConclusionsResults from this study corroborate the safety of non-operative strategy for acute simple appendicitis, as the occurrence of unexpected findings was low, with extremely few necessary changes of the treatment plan because of serious findings. Type of studyPrognosis study. Level of evidenceLevel 2 (retrospective cohort study).

OP015 Cost-effectiveness of laparoscopic ileocecal resection versus infliximab treatment of terminal ileitis in Crohn's disease: the LIR!C TRIAL

OP015 Cost-effectiveness of laparoscopic ileocecal resection versus infliximab treatment of terminal ileitis in Crohn's disease: the LIR!C TRIAL

Terminal Ileitis Induced by Wheat Proteins Allergy: A Case Report

We describe a case report of terminal ileitis and mesenteric adenitis by IgE-mediated allergy to wheat after detecting the culprit proteins by basophil activation test and SDS-PAGE immunoblotting. Gastrointestinal symptoms and terminal ileitis was resolved by avoiding the causative agent. We emphasize the need for a multidisciplinary clinical approach in order to achieve a definitive diagnosis and optimal treatment.

Systemic vasculitis and the gut

Gastrointestinal system can be involved in primary and secondary vasculitides. The recent data regarding the pathophysiology, clinical findings, diagnosis, management, and outcome of gastrointestinal involvement in different types of vasculitis are reviewed. Diagnosis of gastrointestinal vasculitis may be difficult and relies mostly on imaging, because biopsy samples are hard to obtain and superficial mucosal biopsies have a low yield. There are conflicting reports on the association of antineutrophilic cytoplasmic antibodies (ANCA) type with the frequency of gastrointestinal involvement in ANCA-associated vasculitis. Pancreatitis is a rare but serious complication of ANCA-associated vasculitis. Terminal ileitis may be observed in immunoglobulin A vasculitis and can be hard to distinguish from Crohn's disease. High fecal calprotectin levels can indicate active gastrointestinal involvement in both immunoglobulin A vasculitis and Behçet's syndrome. Refractory gastrointestinal involvement in Behçet's syndrome can be treated with thalidomide and/or TNF-α antagonists. The outcome of mesenteric vasculitis in systemic lupus erythematosus can be improved with high-dose glucocorticoids and cyclophosphamide or rituximab. Gastrointestinal system can be commonly involved in immunoglobulin A vasculitis, ANCA-associated vasculitis, polyarteritis nodosa, and Behçet's syndrome and can be an important cause of morbidity and mortality. Treatment depends on the type of vasculitis and is usually with high-dose corticosteroids and immunosuppressives.

Abdominal Pain, Terminal Ileitis, and a Rash: Inflammatory Bowel Disease?

Abdominal Pain, Terminal Ileitis, and a Rash: Inflammatory Bowel Disease?

Prospective Evaluation of Terminal Ileitis in a Surveillance Population of Patients with Ulcerative Colitis.

Ulcerative colitis (UC) is a disease that is normally limited to involvement of the colon. Terminal ileitis in patients with UC with only inactive or mildly active disease has never been investigated. The aim of this prospective study was to determine the prevalence and significance of ileitis among patients with UC enrolled in an endoscopic surveillance program. The study consisted of 72 patients with UC and 90 healthy controls who underwent surveillance and screening colonoscopy, respectively. The endoscopic and histologic features of the terminal ileum (both groups) and colon (UC group only) were evaluated in a standardized fashion. Extensive clinical and endoscopic information was obtained from the subjects, and these data were compared between patients with UC either with or without ileitis. Sixteen of 72 patients with UC (22%) had ileitis compared to only 4 of 90 (4%) of the non-UC controls (P < 0.001). None of the patients had features of backwash. Among patients with UC, the presence of ileitis showed a trend towards correlation with extent of disease, but a significant association with involvement of the colonic side of the ileocecal valve (P = 0.02) was noted. Alcohol use in the week before the colonoscopy was also significant (P = 0.02). There were no other features that were significantly related to ileitis in the patients with UC. Only one UC case with ileitis developed Crohn's disease on follow-up. Ileitis in patients with UC may represent a primary extracolonic manifestation of UC in patients with inactive or mild disease and is not due to backwash.