Isolated Asymptomatic Ileitis Does Not Progress to Overt Crohn Disease on Long-term Follow-up Despite Features of Chronicity in Ileal Biopsies
Isolated Asymptomatic Ileitis Does Not Progress to Overt Crohn Disease on Long-term Follow-up Despite Features of Chronicity in Ileal Biopsies
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DOI：
10.1097/pas.0b013e3181ad25b6
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发表时间：
2009-09-01
影响因子：
5.6
通讯作者：
Srivastava, Amitabh
中科院分区：
文献类型：
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作者：
Courville, Elizabeth L.;Siegel, Corey A.;Srivastava, Amitabh
孤立性回肠异常可在息肉筛查或监测的常规结肠镜检查中发现。这些异常在先前没有炎症性肠病诊断的无症状患者中的意义尚不清楚。一个关键的临床问题是孤立性回肠炎病无症状患者是否是早期克罗恩病（CD）的表现。我们检查了29例孤立性回肠炎患者的临床、内镜和病理资料，这些患者既往无炎症性肠病病史，也无结肠或上消化道受累。仅纳入至少随访2年（范围：2.2 - 12.6年）的患者。29例患者中有15例因胃肠道症状接受了结肠镜检查，而其余14例无症状（筛查结肠镜检查）。在末次随访时，7/15例（47%）归类为慢性活动性回肠炎的患者和3/14例（21%）归类为局灶性活动性回肠炎的患者（油盲组织病理学审查）的临床诊断为CD。14例无症状性回肠炎患者中有11例（79%）存在一种或多种慢性特征，但长期随访无CD油表现。相比之下，8/10例（80%）回肠活检表现为慢性特征的有症状患者进展为CD诊断，2/5例（40%）局灶性活动性回肠炎有症状患者进展为CD诊断。因此，症状的出现似乎是孤立性回肠炎患者进展为CD可能性的最佳预测因素（P
Isolated ileal abnormalities may be detected during routine colonoscopy performed for polyp screening or Surveillance. The significance of these abnormalities in asymptomatic patients without a prior diagnosis of inflammatory bowel disease is unknown. A critical clinical issue is whether isolated ileitis ill asymptomatic patients is a manifestation of early Crohn disease (CD). We examined clinical, endoscopic, and pathologic data from 29 patients with isolated ileitis and no prior history of inflammatory bowel disease, and no colonic or upper gastrointestinal involvement. Only patients with at least 2 years of follow-up (range: 2.2 to 12.6 y) were included. Fifteen of 29 patients had colonoscopy for gastrointestinal symptoms whereas the remaining 14 were asymptomatic (screening colonoscopy). Seven of 15 (47%) of patients categorized as chronic active ileitis and 3 of 14 (21%) of those classified as focal active ileitis, oil blinded histopathologic review, had a clinical diagnosis of CD at last follow-up. One or more features of chronicity were present in 11 of 14 (79%) of asymptomatic ileitis patients but none developed any manifestations of CD oil long-term follow-up. In contrast, 8 of 10 (80%) of symptomatic patients with features Of chronicity in ileal biopsies progressed to a diagnosis of CD, as did 2 of 5 (40%) symptomatic patients with focal active ileitis. Thus, the presence of symptoms seems to be the best predictor of likelihood of progression to CD in patients with isolated ileitis (P