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Colitis pp 231-242 | Cite as

Ileitis

  • Karel Geboes
  • Anne Jouret-Mourin
Chapter

Abstract

Inflammatory pathology of the distal small bowel is relatively common. Three major clinical situations can be considered: a normal-appearing ileum on endoscopy, isolated ileitis, and ileocolitis. Acute enteritis is usually infectious in origin. Histology is not the best method for the diagnosis of enteric infections, because most acute enteritides are non-specific histologically and stool cultures or stool examination has a higher diagnostic yield. Chronic enteritis is less common and most notably caused by chronic infections such as yersiniosis and tuberculosis, by drugs and, in the Western world, primarily by Crohn’s disease. Inflammation called “backwash ileitis” can be present in the terminal ileum in patients with UC. Terminal ileum endoscopy and biopsy are considered as the gold standard for the differential diagnosis of chronic enteritis. The presence of endoscopic lesions and/or a clinical presentation with inflammatory diarrhea are the major indications for a biopsy. As endoscopy is now more frequently performed, pathologists are more likely to receive small intestinal samples and have to know the different features and the possible differential diagnosis between these pathologies.

Keywords

Ileitis Acute enteritis Chronic enteritis Isolated ileitis Ileocolitis Backwash ileitis Crohn ileitis Yersiniosis Tuberculosis 

References

  1. 1.
    McHugh JB, Appelman HD, McKenna BJ. The diagnostic value of endoscopic terminal ileum biopsies. Am J Gastroenterol. 2007;102:1084–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Geboes K, Ectors N, D’Haens G, Rutgeerts P. Is ileoscopy with biopsy worthwhile in patients presenting with symptoms of IBD. Am J Gastroenterol. 1998;93:201–6.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Koksai AR, Boga S, Alkim H, et al. How does a biopsy of endoscopically normal terminal ileum contribute to the diagnosis? Which patients should undergo biopsy? Libyan J Med. 2014;9:23441.CrossRefGoogle Scholar
  4. 4.
    Shah RJ, Fenoglio-Preiser C, Bleau BL, et al. Usefulness of colonoscopy with biopsy in the evaluation of patients with chronic diarrhea. Am J Gastroenterol. 2001;96:1091–5.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Magro F, Langner C, Driessen A, et al. European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis. 2013;7:827–51.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Mojtahed A, Pai RK, Anderson MW, et al. Reactive lymphoid hyperplasia of the terminal ileum: a benign (lymphoma-like) condition that may harbor aberrant immunohistochemical patterns or clonal immunoglobulin heavy chain gene rearrangements. Appl Immunohistochem Mol Morphol. 2014;22:585–92.CrossRefPubMedGoogle Scholar
  7. 7.
    O’Brien BH, McClymont K, Brown I. Collagenous ileitis: a study of 13 cases. Am J Surg Pathol. 2011;35:1151–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Marteau P, Lavergne-Slove A, Lemann M, et al. Primary ileal villous atrophy is often associated with microscopic colitis. Gut. 1997;41:561–4.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Cuvelier C, Barbatis C, Mielants H, et al. Histopathology of intestinal inflammation related to reactive arthritis. Gut. 1987;28:394–401.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Chang HS, Lee D, Kim JC, et al. Isolated terminal ileal ulcerations in asymptomatic individuals: natural course and clinical significance. Gastrointest Endosc. 2010;72:1226–32.CrossRefPubMedGoogle Scholar
  11. 11.
    Goldstein NS. Isolated ileal erosions in patients with mildly altered bowel habits. A follow-up study of 28 patients. Am J Clin Pathol. 2006;125:838–46.CrossRefPubMedGoogle Scholar
  12. 12.
    Lengeling RW, Mitros FA, Brennan JA, et al. Ulcerative ileitis encountered at ileo-colonoscopy: likely role of nonsteroidal agents. Clin Gastroenterol Hepatol. 2003;1:160–9.CrossRefPubMedGoogle Scholar
  13. 13.
    O’Donnell S, Crotty PL, O’Sullivan M, et al. Isolated active ileitis: is it a mild subtype of Crohn's disease? Inflamm Bowel Dis. 2013;19:1815–22.PubMedGoogle Scholar
  14. 14.
    Courville EL, Siegel CA, Vay T, et al. Isolated asymptomatic ileitis does not progress to overt Crohn disease on long term follow-up despite features of chronicity in ileal biopsies. Am J Surg Pathol. 2009;33:1341–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Dilauro S, Crum-Cianflone NF. Ileitis: when it is not Crohn's disease. Curr Gastroenterol Rep. 2010;12:249–58.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hosoe N, Ohmiya N, Hirai F, et al. Chronic enteropathy associated with SLCO2A1 gene (CEAS) - characterization of an enteric disorder to be considered in the differential diagnosis of Crohn's disease. J Crohns Colitis. 2017;11(10):1277–81.CrossRefPubMedGoogle Scholar
  17. 17.
    Levine TS, Price AB. Obstructive enterocolitis: a clinico-pathological discussion. Histopathology. 1994;25:57–64.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Lamps LW. Infective disorders of the gastrointestinal tract. Histopathology. 2007;50:55–63.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Vantrappen G, Ponette E, Geboes K, et al. Yersinia enteritis and enterocolitis: gastroenterological aspects. Gastroenterology. 1977;72:220–7.PubMedGoogle Scholar
  20. 20.
    Naktin J, et al. Yersinia enterocolitica and Yersinia pseudotuberculosis. Clin Lab Med. 1999;19:523–36.PubMedCrossRefGoogle Scholar
  21. 21.
    Aabakken L. Small-bowel side-effects of non-steroidal anti-inflammatory drugs. Eur J Gastroenterol Hepatol. 1999;11:383–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Messmer H, Upreti S, Tarabishy Y, et al. Ipilimumab-induced enteritis without colitis: a new challenge. Case Rep Oncol. 2016;9:705–13.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Théophile H, David XR, Miremont-Salamé G, Haramburu F. Five cases of sprue-like enteropathy in patients treated with olmesartan. Dig Liver Dis. 2014;46:465–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Geboes K, Ectors N, D’Haens G, Rutgeerts P. In: Tytgat GNJ, Bartelsman JFWM, van Deventer SJH, editors. The value of ileal biopsies in the diagnosis of IBD: inflammatory bowel diseases. Dordrecht: Kluwer Academic Publishers; 1995. p. 115–21.Google Scholar
  25. 25.
    Wright NA, Pike C, Elia G. Induction of a novel epidermal growth factor secreting cell lineage by mucosal ulceration in human gastrointestinal stem cells. Nature. 1990;343:82–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Setaffy L, Osuna MJM, Plieschnegger W, et al. Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), and neuromuscular and vascular hamartoma (NMVH): two sides of the same coin? Endoscopy. 2015;47:1–4.Google Scholar
  27. 27.
    Kobayashi M, Ito M, Nakagawa A, et al. Neutrophil and endothelial cell activation in the vasa vasorum in vasculo-Behcet disease. Histopathology. 2000;36:362–71.CrossRefPubMedGoogle Scholar
  28. 28.
    Goldstein N, Dulai M. Contemporary morphological definition of backwash ileitis in ulcerative colitis and features that distinguish it from Crohn’s disease. Am J Clin Pathol. 2006;126:365–76.CrossRefPubMedGoogle Scholar
  29. 29.
    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;29:1472–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Karel Geboes
    • 1
    • 2
  • Anne Jouret-Mourin
    • 3
  1. 1.Department of PathologyGhent University HospitalGhentBelgium
  2. 2.Department of PathologyKU LeuvenLeuvenBelgium
  3. 3.Department of PathologyCliniques Universitaires St Luc, UCLBrusselsBelgium

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