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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2017; 9(7): 327-333
Published online Jul 16, 2017. doi: 10.4253/wjge.v9.i7.327
All ileo-cecal ulcers are not Crohn’s: Changing perspectives of symptomatic ileocecal ulcers
Jay Toshniwal, Romesh Chawlani, Amit Thawrani, Rajesh Sharma, Anil Arora, Hardik L Kotecha, Mohan Goyal, Vijendra Kirnake, Pankaj Jain, Pankaj Tyagi, Naresh Bansal, Munish Sachdeva, Piyush Ranjan, Mandhir Kumar, Praveen Sharma, Vikas Singla, Rinkesh Bansal, Vineet Shah, Sunita Bhalla, Ashish Kumar
Jay Toshniwal, Department of Gastroenterology, Dr.Toshniwal’s Gastro-Liver Care, Aurangabad 431001, India
Jay Toshniwal, Romesh Chawlani, Amit Thawrani, Rajesh Sharma, Anil Arora, Hardik L Kotecha, Mohan Goyal, Vijendra Kirnake, Pankaj Jain, Pankaj Tyagi, Naresh Bansal, Munish Sachdeva, Piyush Ranjan, Mandhir Kumar, Praveen Sharma, Vikas Singla, Rinkesh Bansal, Vineet Shah, Ashish Kumar, Department of Gastroenterology, Sir Gangaram Hospital, New Delhi 110060, India
Sunita Bhalla, Department of Histo-pathology, Sir Gangaram Hospital, New Delhi 110060, India
Author contributions: Toshniwal J performed the research, collected the data and wrote the paper; Kumar A contributed to the analysis; Chawlani R, Thawrani A, Sharma R, Kotecha HL, Goyal M, Kirnake V, Jain P, Tyagi P, Bansal N, Sachdeva M, Singla V, Bansal R, Sharma P and Shah V provided clinical advice; Arora A, Kumar M, Ranjan P and Bhalla S designed and supervised the study.
Institutional review board statement: This study was conducted in accordance with the principles of the Declaration of Helsinki, and written informed consent for the treatment and colonoscopy was obtained from all patients. We did not seek individual ethical approval by the Committee because this was an observational study without interpositions and with the medical practice necessary for therapeutic purposes.
Informed consent statement: Informed consent from the included patients was not obtained to participate in the study. However, each patient provided written informed consent for undergoing colonoscopy and treatment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Jay Toshniwal, MBBS, MD, DNB, Department of Gastroenterology, Sir Gangaram Hospital, Rajinder Nagar, New Delhi 110060, India.
drjaytoshniwal@yahoo.com
Telephone: +91-95-95430747 Fax: +91-11-25861002
Received: January 27, 2017
Peer-review started: February 4, 2017
First decision: March 22, 2017
Revised: May 6, 2017
Accepted: June 6, 2017
Article in press: June 7, 2017
Published online: July 16, 2017
Processing time: 158 Days and 19.5 Hours
AIM
To investigated clinical, endoscopic and histopathological parameters of the patients presenting with ileocecal ulcers on colonoscopy.
METHODS
Consecutive symptomatic patients undergoing colonoscopy, and diagnosed to have ulcerations in the ileocecal (I/C) region, were enrolled. Biopsy was obtained and their clinical presentation and outcome were recorded.
RESULTS
Out of 1632 colonoscopies, 104 patients had ulcerations in the I/C region and were included in the study. Their median age was 44.5 years and 59% were males. The predominant presentation was lower GI bleed (55, 53%), pain abdomen ± diarrhea (36, 35%), fever (32, 31%), and diarrhea alone (9, 9%). On colonoscopy, terminal ileum was entered in 96 (92%) cases. The distribution of ulcers was as follows: Ileum alone 40% (38/96), cecum alone 33% (32/96), and both ileum plus cecum 27% (26/96). The ulcers were multiple in 98% and in 34% there were additional ulcers elsewhere in colon. Based on clinical presentation and investigations, the etiology of ulcers was classified into infective causes (43%) and non-infective causes (57%). Fourteen patients (13%) were diagnosed to have Crohn’s disease (CD).
CONCLUSION
Non-specific ileocecal ulcers are most common ulcers seen in ileo-cecal region. And if all infections are clubbed together then infection is the most common (> 40%) cause of ulcerations of the I/C region. Cecal involvement and fever are important clues to infective cause. On the contrary CD account for only 13% cases as a cause of ileo-cecalulcers. So all symptomatic patients with I/C ulcers on colonoscopy are not Crohn’s.
Core tip: This is one of the largest studies till date defining etiology, endoscopic and histological features of ileocecal (I/C) ulcers. Non-specific ileocecal ulcers are most common ulcers seen in ileo-cecal region. And if all infections are clubbed together then infection is the the most common (> 40%) cause of ulcerations of the IC region. On the contrary Crohn’s disease (CD) account for only 13% cases as a cause of ileo-cecal ulcers. So all symptomatic patients with I/C ulcers on colonoscopy are not CD. Also, we conclude that with increasing use of Colonoscope in diagnosis and treatment, majority of the patients with ileo-cecal ulcers can be managed conservatively without surgery.
