Ileoscopy is increasingly practiced. However, if ulcerations are encountered the appropriate diagnostic and management decisions are unclear.
In this study, Dr Randall Lengeling from Dubuque, Iowa, identified 40 patients with ulcerative ileitis during 1900 consecutive ileoscopies in a community practice.
Dr Leungling's team analyzed the clinical, endoscopic, and histopathologic findings in these patients. They related these findings to drug usage.
The team found that most patients were asymptomatic, however ileitis contributed to blood loss in 14, and to right lower quadrant pain in 1.
Endoscopy revealed multiple, discrete, fibrin-covered ulcerations in the prevalvular segment, with patches of erythematous stippling, normal intervening mucosa, and occasional mucosal scars or webs.
In addition, histologic findings included focal superficial neutrophilic infiltrates, edema, mucosal hemorrhage, lymphatic dilatation, fibromuscular hyperplasia, prominence of the muscularis mucosae, and antral and Paneth cell metaplasia.
The team found that granulomas, fissure ulcers, and apoptosis were notably absent.
|Of the 40 patients with ulcerative ileitis, 33 had recently taken NSAIDs.|
|Clinical Gastroenterology and Hepatology|
No specific disease process developed in a median follow-up of 3.2 years.
Of the 40 patients, 33 admitted recently taking nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs included enteric-coated aspirin at 325 mg per day or less (n=19), selective cyclooxygenase-2 inhibitors (n=5), and nonacetylated salicylates (n=3).
The team determined that three quarters of NSAID were taking agents with low or intermediate gastroduodenal toxicity.
The researchers found that the lesions disappeared after drug withdrawal, and reappeared on resumption of the NSAIDs.
Dr Randall Lengeling's team concluded, "Ileoscopy during colonoscopy may identify an ulcerative ileitis".
"This lesion likely contributes to gastrointestinal blood loss and other clinical manifestations, and likely is caused by NSAID use, including those usually associated with low toxicity or at low doses".
"Features of NSAID-ileitis overlap with Crohn's ileitis, but differentiation of the 2 entities is critical for appropriate management".