Published online Jul 16, 2017. doi: 10.4253/wjge.v9.i7.327
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
To investigated clinical, endoscopic and histopathological parameters of the patients presenting with ileocecal ulcers on colonoscopy.
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.
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).
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.