Journal Article

Nonspecific ileitis: Impact of histopathology and gastrointestinal ultrasound in achieving the diagnosis of Crohn's disease

Taylor, Kirstin M, Friedman, Antony B, Perera, Natalie, Smith, Rebecca L, Majeed, Ammar, Gibson, Peter R

2022

Overview

Background and Aim Nonspecific ileitis is inflammation of the ileum without specific diagnostic features. A minority may go on to develop Crohn's disease, but optimal pathways of further investigation have not been established. This study aimed to identify a cohort of patients with nonspecific ileitis and to determine the value of ileal histology and gastrointestinal ultrasound in identifying/excluding Crohn's disease. Patients and Methods In a retrospective analysis, all patients having nonspecific ileitis at colonoscopy from January 2010 to August 2021 were identified. Clinical associations with those subsequently diagnosed with Crohn's disease were examined with specific reference to ileal histology and gastrointestinal ultrasound. Results Of 29 638 procedures, 147 patients (0.5%) had nonspecific ileitis. Crohn's disease was subsequently diagnosed in 8 patients (5.4%) at a median of 148 (range 27–603) days after colonoscopy. The presence of chronic inflammation on ileal biopsies was more common in those subsequently diagnosed with Crohn's disease (63% vs 20%; P = 0.0145). On gastrointestinal ultrasound, none of the 26 patients with normal bowel wall thickness (<3 mm) were subsequently diagnosed with Crohn's disease, and repeat ultrasound in 15 patients 1 year later showed no change. Of the nine patients with abnormal sonographic findings, three were diagnostic for Crohn's disease. Repeat ultrasound revealed Crohn's disease in two, while four had resolution of the abnormal findings. Conclusion Although ileal histology was of limited value in identifying patients with nonspecific ileitis who were subsequently diagnosed with Crohn's disease, gastrointestinal ultrasound was highly informative. Prospective studies are needed to confirm the value of gastrointestinal ultrasound as a diagnostic and monitoring tool in this setting. Non‐specific ileitis at ileocolonoscopy may progress to Crohn's disease in a proportion of patients. In this study, we show that the likelihood of this is occurring is low (5.4%). Furthermore, the use of gastrointestinal ultrasound after identifying non‐specific ileitis, may be useful in identifying those that may progress to Crohn's disease.

• Publisher: Wiley Publishing Asia Pty Ltd,John Wiley & Sons, Inc,Wiley
• Subject: Colonoscopy / COVID-19 / Crohn's disease / Endoscopy / gastroenterology / Histology / Histopathology / IBD: clinical trials / imaging and advanced technology/applied therapeutics / Inflammation / intestinal disorders / Medical records / Medical screening / Nonsteroidal anti-inflammatory drugs / Original / Patients / screening and diagnosis / Small intestine / Systematic review / Ulcers / Ultrasonic imaging