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Identifying infectious colitis in patients with ileocecal ulcers

This month's issue of the Clinical Gastroenterology & Hepatology evaluates combined endoscopy, aspiration, and biopsy analysis for identifying infectious colitis in patients with ileocecal ulcers.

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The ileocecal area is commonly involved in infection and inflammatory colonic diseases, but differential diagnosis can be difficult.

Dr Naoyoshi Nagata and colleagues identified definitive endoscopic findings and a sample collection method for diagnosing infectious colitis.

The team performed a retrospective study, and analyzed data on 128 patients with ileocecal ulcer who underwent colonoscopy from 2007–2011 at the National Center for Global Health and Medicine in Tokyo, Japan. 

The research team collected information on location, size, number, and distinctive endoscopic findings and estimated diagnostic odds ratios.

The team of doctors compared the sensitivities of microscopy, culture, polymerase chain reaction, and histologic methods in identifying patients with infection with those of standard stool, endoscopic aspirated intestinal fluid, or biopsy analyses.

Methods that detected infection with the highest sensitivity included biopsy with histology for amebiasis
Clinical Gastroenterology and Hepatology

Of the 128 patients, 100 had infections, and 28 had Crohn's disease, Behçet's disease, or other inflammatory diseases.

Predictive endoscopic findings included amebiasis of the cecum, with exudates and round-shaped ulcer, for tuberculosis with transverse-shaped ulcer, scar, linear-shaped ulcer, or 10 mm in size,; for cytomegalovirus with round-shaped ulcer; and for Campylobacter with cecal valve lesion or 10 mm.

The team found that the sensitivity of endoscopic sample collection was significantly higher than that of standard stool sample collection for the diagnosis of amebiasis, tuberculosis, non-tuberculosis mycobacteria, and other bacteria.

The doctors noted that the methods that detected infection with the highest levels of sensitivity were biopsy with histology for amebiasis, biopsy with culture for tuberculosis, biopsy with polymerase chain reaction for cytomegalovirus, and aspiration of intestinal fluid with culture for Campylobacter.

Dr Nagata's team commented, "Combining results from endoscopic analysis with appropriate sample collection and pathogen detection methods enables infectious colitis to be differentiated from other noninfectious colonic diseases."

Clin Gastroenterol and Hepatol 2013:11(6): 673-680
01 July 2013

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