The Clinical Significance of Active Ileitis and Chronic Active Ileitis: Clinicopathologic Study of 72 Cases.
Rebecca M Ziegler, Jeffrey T Wenzke, Amy Lehman, Wendy L Frankel, Martha M Yearsley. The Ohio State University, Columbus
Background: Biopsy of the terminal ileum (TI) is a common procedure for evaluating diarrhea, abdominal pain, anemia, and rectal bleeding. Ileitis may be seen in the setting of ischemia, medication effect, infectious disease, and inflammatory bowel disease, among others. The pathologist usually renders a differential diagnosis, and clinicopathologic correlation is very important. The aim of the study was to correlate TI and associated colonic findings with the final clinical impression to assess the significance of these patterns of inflammation.
Design: Using our institutional database, 93 patients were identified with at least one TI biopsy diagnosed as either active ileitis (AI) or chronic active ileitis (CAI) within a five year period (2005-2010). TI and any concomitant colonic biopsies were reviewed by two pathologists. The inflammation pattern was evaluated in the TI. Colonic biopsies were noted to have either normal or abnormal histology. Up to 5-year clinical follow up was available for 72 cases and the clinical, endoscopic, and radiographic findings were noted.
Results: Of 93 patients (mean age 41 years, 55% female) with TI biopsies, the final clinical diagnostic information was not available in 21, resulting in 72 patients with 28 diagnosed as AI and 44 diagnosed with CAI. The final clinical diagnoses for patients with AI were 21 Crohn disease (CD) (75%), 3 medication effect (11%), 1 ulcerative colitis (UC) (4%), 1 prior intestinal surgery (4%), and 2 unknown (7%). The final clinical diagnoses for patients with CAI were 36 CD (82%), 1 medication effect (2%), 2 UC (5%), 2 prior intestinal surgery (5%), 1 graft versus host disease (GVHD) (2%), and 2 cytomegalovirus (CMV) (5%). Incorporating the colonic histologic findings with the TI diagnoses, 35 patients were excluded due to missing final clinical diagnoses and/or colonic biopsies, resulting in 58 patients. Diagnoses of the 6 patients with AI and normal colons were 4 CD (67%), 1 medication effect (17%), and 1 unknown (7%). The 15 patients with AI and abnormal colons had 10 CD (67%), 2 medication effect (14%), 1 UC (7%), 1 prior intestinal surgery (7%), and 1 unknown (7%). Diagnoses of the 8 patients with CAI and normal colons were 6 CD (76%), 1 medication effect (13%), and 1 prior intestinal surgery (13%). Those with CAI and abnormal colons included 24 CD (83%), 2 CMV (7%), 2 UC (7%), and 1 GVHD (3%).
Conclusions: These results show that the majority of final clinical diagnoses in patients with AI or CAI regardless of the colonic findings represent CD. Other diagnoses are less likely but should remain in the differential.
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 23, Wednesday Morning