Isolated Ileitis May Be a Manifestation of Crohn's Disease, but Only in Symptomatic Patients: A Multi-Institution Study of 131 Cases
Jeanne Shen, Robert M Najarian, Ben Dessauvagie, Vikram Deshpande, M Priyanthi Kumarasinghe, Matthew Hamilton, Mohammad Shahid, Gregory Lauwers, Robert D Odze, Amitabh Srivastava. Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; PathWest & UWA, Perth, Australia; Massachusetts General Hospital, Boston, MA
Background: Isolated ileitis may be detected during diagnostic work-up in symptomatic patients, or as an incidental finding on screening colonoscopy in asymptomatic patients. Its clinical significance in patients without a prior diagnosis of inflammatory bowel disease is unknown. The current study was performed to determine clinical and pathologic features predictive of progression to Crohn's disease (CD) in patients with an isolated ileitis.
Design: 131 patients from 4 medical centers met our inclusion criteria of 1) index colonoscopy with definite endoscopic and histologic evidence of ileitis, and 2) at least 2 years of clinical follow-up. Patients with 1) a prior diagnosis of, or suspicion for IBD, 2) presence of colonic or upper gastrointestinal tract involvement, or 3) surgical pathology material unavailable for review, were excluded. Each case was histologically categorized into chronic active ileitis (CAI) or focal active ileitis (FAI), and clinical and endoscopic data was retrieved by chart review. Uni- and multivariate analysis was used to determine predictors of progression to CD.
Results: The study group consisted of 47 men and 84 women (mean age: 48 yrs; range 15-87 yrs). 84/131 patients underwent colonoscopy for diagnostic workup of either gastrointestinal symptoms (77) or abnormal laboratory findings (7). Abdominal pain (50.6%), diarrhea (42.8%), and rectal bleeding (22.1%) were the most common reported symptoms. 47/131 patients were asymptomatic, and ileitis was an incidental finding on screening colonoscopy. Endoscopic abnormalities were similar in both symptomatic and asymptomatic patients, the most common being aphthous erosions (41.5%), ulcers (34.4%), and erythema (39.7%). 20/131 patients had a definite diagnosis of CD at last follow-up (range 24-144 mth; mean 61 mth), and all were from the symptomatic group (20/83; 24%). This included 10/21 (48%) patients with CAI (OR=8.7, 95% CI [2.3, 33.2]), and 10/62 (16%) with FAI. In contrast, no patients with incidental asymptomatic ileitis (n=47) progressed to CD on follow-up (range 24-160 mth; mean 67 mth), including 7/47 (15%) with CAI.
Conclusions: Overall, 24% of symptomatic patients with an isolated ileitis progress to CD, and the risk is significantly higher (48%) in those with CAI. However, isolated asymptomatic ileitis detected incidentally during screening colonoscopy does not progress to CD, and should be managed conservatively.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 116, Monday Morning