Ileitis, or inflammation of the ileum, is often caused by Crohn’s disease. However, ileitis may be caused by a wide variety of other diseases. These include infectious diseases, spondyloarthropathies, vasculitides, ischemia, neoplasms, medication-induced, eosinophilic enteritis, and others. The clinical presentation of ileitis may vary from an acute and self-limited form of right lower quadrant pain and/or diarrhea, as in the majority of cases of bacterial ileitis, but some conditions (ie, vasculitis or Mycobacterium tuberculosis) follow a chronic and debilitating course complicated by obstructive symptoms, hemorrhage, and/or extraintestinal manifestations. Ileitis associated with spondylarthropathy or nonsteroidal anti-inflammatory drugs is typically subclinical and often escapes detection unless further testing is warranted by symptoms. In a minority of patients with long-standing Crohn’s ileitis, the recrudescence of symptoms may represent a neoplasm involving the ileum. Distinguishing between the various forms of ileitis remains a test of clinical acumen. The diagnosis of the specific etiology is suggested by a detailed history and physical examination, laboratory testing, and ileocolonoscopy and/or radiologic data.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Matsumoto T, Iida M, Matsui T, et al.: Endoscopic findings in Yersinia enterocolitica enterocolitis. Gastrointest Endosc 1990, 36:583–587.
Puylaert JB, Van der Zant FM, Mutsaers JA: Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella: clinical, radiological and US findings. Eur Radiol 1997, 7:3–9.
Crum-Cianflone NF: Salmonellosis and the gastrointestinal tract: more than just peanut butter. Curr Gastroenterol Rep 2008, 10:424–431.
Balthazar EJ, Charles HW, Megibow AJ: Salmonella and Shigella-induced ileitis: CT findings in four patients. J Comput Assist Tomogr 1996, 20:375–378.
Lavallee C, Laufer B, Pepin J, et al.: Fatal Clostridium difficile enteritis caused by the BI/NAP1/027 strain: a case series of ileal C. difficile infections. Clin Microbiol Infect 2009, 15:1093–1099.
•• Causey MW, Spencer MP, Steele SR: Clostridium difficile enteritis after colectomy. Am Surg 2009, 75:1203–1206. This article reviews the current available literature on C. difficile enteritis by presenting three cases occurring after colectomy. The authors emphasize the importance of recognizing this potentially serious condition in postoperative colectomy patients who present with low-grade fevers, abdominal or pelvic pain, and increased ileostomy output.
Benya EC, Sivit CJ, Quinones RR: Abdominal complications after bone marrow transplantation in children: sonographic and CT findings. AJR Am J Roentgenol 1993, 161:1023–1027.
Cartoni C, Dragoni F, Micozzi A, et al.: Neutropenic enterocolitis in patients with acute leukemia: prognostic significance of bowel wall thickening detected by ultrasonography. J Clin Oncol 2001, 19:756–761.
Leung VK, Law ST, Lam CW, et al.: Intestinal tuberculosis in a regional hospital in Hong Kong: a 10-year experience. Hong Kong Med J 2006, 12:264–271.
•• Donoghue HD, Holton J: Intestinal tuberculosis. Curr Opin Infect Dis 2009, 22:490–496. This article is an excellent review of the epidemiology, presentation, diagnostic techniques, and management of intestinal TB.
• Das K, Ghoshal UC, Dhali GK, et al.: Crohn’s disease in India: a multicenter study from a country where tuberculosis is endemic. Dig Dis Sci 2009, 54:1099–1107. This retrospective study describes the demographic and clinical parameters of 186 patients reported from 2000 to 2007 with Crohn’s disease from India. It then considers the differentiation of Crohn’s disease from intestinal TB.
Amarapurkar DN, Patel ND, Rane PS: Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent. World J Gastroenterol 2008, 14:741–746.
Ghoshal UC, Ghoshal U, Singh H, Tiwari S: Anti-Saccharomyces cerevisiae antibody is not useful to differentiate between Crohn’s disease and intestinal tuberculosis in India. J Postgrad Med 2007, 53:166–170.
Boudiaf M, Zidi SH, Soyer P, et al.: Tuberculous colitis mimicking Crohn’s disease: utility of computed tomography in the differentiation. Eur Radiol 1998, 8:1221–1223.
•• Makharia GK, Srivastava S, Das P, et al.: Clinical, endoscopic, and histological differentiations between Crohn’s disease and intestinal tuberculosis. Am J Gastroenterol 2010, 105:642–651. This excellent study highlights certain features that are more common in Crohn’s disease including blood in stool, involvement of the left side of the colon, and focally enhanced colitis. A score devised by the authors proved useful in differentiating between CD and intestinal TB.
Lee YJ, Yang SK, Byeon JS, et al.: Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn’s disease. Endoscopy 2006, 38:592–597.
Uzunkoy A, Harma M, Harma M: Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literature. World J Gastroenterol 2004, 10:3647–3649.
Pulimood AB, Ramakrishna BS, Kurian G, et al.: Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn’s disease from tuberculosis. Gut 1999, 45:537–541.
Gillin JS, Urmacher C, West R, Shike M: Disseminated Mycobacterium avium-intracellulare infection in acquired immunodeficiency mimicking Whipple’s disease. Gastroenterology 1983, 85:1187–1191.
Nyberg DA, Federle MP, Jeffrey RB, et al.: Abdominal CT findings of disseminated Mycobacterium avium-intracellulare in AIDS. AJR Am J Roentgenol 1985, 145:297–299.
Cintron JR, Del Pino A, Duarte B, Wood D: Abdominal actinomycosis. Dis Colon Rectum 1996, 39:105–108.
Harris LF, Kakani PR, Selah CE: Actinomycosis. Surgical aspects. Am Surg 1985, 51:262–264.
Bouree P, Paugam A, Petithory JC: Anisakidosis: report of 25 cases and review of the literature. Comp Immunol Microbiol Infect Dis 1995, 18:75–84.
Chamberlain RS, Atkins S, Saini N, White JC: Ileal perforation caused by cytomegalovirus infection in a critically ill adult. J Clin Gastroenterol 2000, 30:432–435.
Baroco AL, Oldfield EC: Gastrointestinal cytomegalovirus disease in the immunocompromised patient. Curr Gastroenterol Rep 2008, 10:409–416.
Kahi CJ, Wheat LJ, Allen SD, Sarosi GA: Gastrointestinal histoplasmosis. Am J Gastroenterol 2005, 100:220–231.
Cappell MS, Mandell W, Grimes MM, Neu HC: Gastrointestinal histoplasmosis. Dig Dis Sci 1988, 33:353–360.
Mielants H, Veys EM, De Vos M, et al.: The evolution of spondyloarthropathies in relation to gut histology. I. Clinical aspects. J Rheumatol 1995, 22:2266–2272.
Mielants H, Veys EM, Cuvelier C, et al.: The evolution of spondyloarthropathies in relation to gut histology. II. Histological aspects. J Rheumatol 1995, 22:2273–2278.
Passam FH, Diamantis ID, Perisinaki G, et al.: Intestinal ischemia as the first manifestation of vasculitis. Semin Arthritis Rheum. 2004, 34:431–441.
Karagozian R, Turbide C, Szilagyi A: Henoch-Schönlein purpura presenting with ileal involvement in an adult. Dig Dis Sci 2004, 49:1722–1726.
Byun JY, Ha HK, Yu SY, et al.: CT features of systemic lupus erythematosus in patients with acute abdominal pain: emphasis on ischemic bowel disease. Radiology 1999, 211:203–209.
Cangemi JR, Picco MF: Intestinal ischemia in the elderly. Gastroenterol Clin North Am 2009, 38:527–540.
Hoeffel C, Crema MD, Belkacem A, et al.: Multi-detector row CT: spectrum of diseases involving the ileocecal area. Radiographics 2006, 26:1373–1390.
Solem CA, Harmsen WS, Zinsmeister AR, Loftus EV Jr: Small intestinal adenocarcinoma in Crohn’s disease: a case-control study. Inflamm Bowel Dis 2004, 10:32–35.
Hsu EY, Feldman JM, Lichtenstein GR: Ileal carcinoid tumors stimulating Crohn’s disease: incidence among 176 consecutive cases of ileal carcinoid. Am J Gastroenterol 1997, 92:2062–2065.
Allison MC, Howatson AG, Torrance CJ, et al.: Gastrointestinal damage associated with the use of nonsteroidal anti-inflammatory drugs. N Engl J Med 1992, 327:749–754.
Graham DY, Opekun AR, Willingham FF, Qureshi WA: Visible small-intestinal mucosal injury in chronic NSAID users. Clin Gastroenterol Hepatol 2005, 3:55–59.
Lang J, Price AB, Levi AJ, et al.: Diaphragm disease: the pathology of non-steroidal anti-inflammatory drug induced small intestinal strictures. J Clin Pathol 1988, 41:516–526.
Sigthorsson G, Tibble J, Hayllar J, et al.: Intestinal permeability and inflammation in patients on NSAIDs. Gut 1998, 43:506–511.
Tibble JA, Sigthorsson G, Foster R, et al.: High prevalence of NSAID enteropathy as shown by a simple faecal test. Gut 1999, 45:362–366.
• Hayashi Y, Yamamoto H, Taguchi H, et al.: Nonsteroidal anti-inflammatory drug-induced small-bowel lesions identified by double-balloon endoscopy: endoscopic features of the lesions and endoscopic treatments for diaphragm disease. J Gastroenterol 2009, 44(Suppl 19):57–63. This is a retrospective case study of 18 patients illustrating the clinical features of NSAID enteropathy. Endoscopic balloon dilation therapy was safe and effective for diaphragm disease.
Gut lesions due to slow-release KCl tablets. N Engl J Med 1977, 296:111–112.
Geltner D, Sternfeld M, Becker SA, Kori M: Gold-induced ileitis. J Clin Gastroenterol 1986, 8:184–186.
Daneshjoo R, J Talley N: Eosinophilic gastroenteritis. Curr Gastroenterol Rep. 2002, 4:366–372.
Wedemeyer J, Vosskuhl K: Role of gastrointestinal eosinophils in inflammatory bowel disease and intestinal tumours. Best Pract Res Clin Gastroenterol 2008, 22:537–549.
Ebert EC, Kierson M, Hagspiel KD: Gastrointestinal and hepatic manifestations of sarcoidosis. Am J Gastroenterol 2008, 103:3184–3192.
•• Ebert EC, Nagar M: Gastrointestinal manifestations of amyloidosis. Am J Gastroenterol 2008, 103:776–787. This article provides a comprehensive overview of amyloidosis and small bowel involvement. The authors emphasize the need for a high index of clinical suspicion for this rare diagnosis in certain high-risk groups (ie, patients with chronic inflammatory diseases, certain infections, or malignancy, and patients with renal disease on dialysis).
Haskell H, Andrews CW Jr, Reddy SI, et al.: Pathologic features and clinical significance of “backwash” ileitis in ulcerative colitis. Am J Surg Pathol 2005, 29:1472–1481.
• De Ceglie A, Bilardi C, Blanchi S, et al.: Acute small bowel obstruction caused by endometriosis: a case report and review of the literature. World J Gastroenterol 2008, 14:3430–3434. The authors report an interesting case in which endometrial infiltration of the ileum caused acute obstruction requiring emergency surgery in a woman whose symptoms were not related to menses.
Cappell MS, Friedman D, Mikhail N: Endometriosis of the terminal ileum simulating the clinical, roentgenographic, and surgical findings in Crohn’s disease. Am J Gastroenterol 1991, 86:1057–1062.
The content of this publication is the sole responsibility of the authors and does not necessarily reflect the views or policies of the National Institutes of Health or the Department of Health and Human Services, the Department of Defense, or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the US Government. This work is original and has not been published elsewhere.
Dr. Crum-Cianflone has received research funding from the National Institute of Allergy and Infectious Diseases. No other potential conflict of interest relevant to this article was reported.
About this article
Cite this article
DiLauro, S., Crum-Cianflone, N.F. Ileitis: When It is Not Crohn’s Disease. Curr Gastroenterol Rep 12, 249–258 (2010). https://doi.org/10.1007/s11894-010-0112-5
- Crohn’s disease
- Infectious ileitis
- Clostridium difficile
- Mycobacterium tuberculosis
- Mycobacterium avium
- NSAID enteropathy
- Eosinophilic enteritis
- Backwash ileitis