Symptomatic isolated terminal ileal ulcers: etiology and clinical significance.
Symptomatic isolated terminal ileal ulcers: etiology and clinical significance.
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DOI：
10.1055/s-0043-100688
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发表时间：
2017-07
影响因子：
2.6
通讯作者：
Sood A
中科院分区：
文献类型：
--
作者：
Mehta V;Gupta A;Mahajan R;Narang V;Midha V;Sood N;Kaur H;Kaur K;Sood A
随着回肠插管次数的增加，结肠镜检查中经常发现孤立性末端回肠溃疡（ITIU）。本研究的目的是研究这些溃疡的病因和临床意义的患者有胃肠道症状。 这是一项前瞻性观察性研究，对2014年1月1日至2014年12月31日期间因各种胃肠道症状接受回结肠镜检查的连续患者进行了研究。对ITIU患者的临床、内镜和组织学结果进行了评估，以确定病因，并对其进行了相应的治疗。 在初步诊断后3-6个月内评估症状缓解情况，并对同意的患者重复结肠镜检查。 在1497例回结肠镜检查发现ITIU的患者中，有74例（4.9%）在初始检测时发现了特定病因。 3 - 6个月随访后，44例（59.5%）患者确定了明确诊断[克罗恩病（CD）：19例（25.7%），NSAID诱导的溃疡：11例（14.9%），肠结核（ITB）：9例（12.2%），嗜酸性粒细胞性肠炎：5例（6.8%）]，30例患者（40.5%）有非特异性溃疡。 治疗后，分别在55/60例患者（91.7%）和28/36例患者（77.8%）中观察到症状和内窥镜消退。 在5/60例仍有症状的患者中，3例最初诊断为非特异性溃疡，2例诊断为CD，最终分别诊断为CD和ITB，并接受相应治疗。 在有胃肠道症状的患者中，超过一半的ITIU有特定的病因，及时诊断和适当治疗可以预防严重并发症。非特异性溃疡可以通过对症治疗进行管理，但在症状持续的情况下需要密切监测和重新评估。
With an increasing number of ileal intubations, isolated terminal ileal ulcers (ITIU) are frequently found during colonoscopies. The present study aimed at studying the etiology and clinical significance of these ulcers in patients having gastrointestinal symptoms. This was a prospective observational study performed on consecutive patients who underwent ileocolonoscopy for various gastrointestinal symptoms between 1 January 2014 and 31 December 2014. Clinical, endoscopic, and histological findings of patients with ITIUs were assessed to determine the etiology and they were treated accordingly. Symptom resolution was assessed within 3 – 6 months of initial diagnosis, and colonoscopy was repeated for consenting patients. Among 74 (4.9 %) of 1497 patients who had ITIUs on ileocolonoscopy, 41 (55.4 %) had specific etiologies on initial testing. After 3 – 6 months follow-up, definitive diagnosis was ascertained in 44 (59.5 %) patients [Crohn’s disease (CD): 19 (25.7 %), NSAID-induced ulcers: 11 (14.9 %), intestinal tuberculosis (ITB): 9 (12.2 %), and eosinophilic enteritis: 5 (6.8 %)], and 30 patients (40.5 %) had nonspecific ulcers. After treatment, symptomatic and endoscopic resolution were noted in 55/60 patients (91.7 %) and 28/36 patients (77.8 %), respectively. Of 5/60 patients who remained symptomatic, three were initially diagnosed with nonspecific ulcers and two with CD, and they were finally diagnosed with CD and ITB respectively, and treated accordingly. In patients with gastrointestinal symptoms, more than half of the ITIUs have specific etiologies, and timely diagnosis and appropriate treatment can prevent serious complications. Nonspecific ulcers can be managed with symptomatic treatment, but need close monitoring and re-evaluation in the case of persistence of symptoms.