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P071. Are isolated ileal abnormalities a clinically relevant entity? A retrospective study

S. Bollani, C. Facciotto, S. Bruno, S. Saibeni

Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy

Background: Asymptomatic or paucisymptomatic ileitis is an emerging clinical entity whose clinical relevance has not been fully investigated. In particular, whether it represents an early manifestation or a milder variant of Crohn's disease is still poorly understood.

Aim: To evaluate the clinical outcome of isolated ileal alterations occasionally observed during outpatient gastroenterological activity.

Methods: We retrospectively evaluated all consecutive case-histories of patients admitted for gastroenterological evaluation between April 2007 and October 2009 in our Department. For the purpose of this study only patients with isolated ileal lesions without prior gastrointestinal history, in whom use of drugs (especially NSAIDs), presence of celiac disease and parasitic infestations were ruled out and no significant alterations were observed at blood chemistry, were considered. We defined ileitis as the presence of at least one of the following signs observed during retrograde ileoscopy: erythema, edema, nodularity, aftae, erosions, ulcers.

Results: Among 1,042 subjects examined, 16 patients (8 men, mean age 43.6±12.9 years) who showed the above-mentioned features were identified. They had underwent colonoscopy for the following reasons: IBS-like symptoms (n = 7), rectal bleeding (n = 4), polyp screening (n = 3), systemic symptoms (fever, weight loss, anorexia) (n = 1), CA 19–9 value abnormality (n = 1). Patients were followed-up for a median time of 28 months (range 11–86). The observed ileal lesions were the following: ulcers (n = 3), erosions (n = 7), nodularity (n = 3), aftae (n = 2), erythema (n = 1). All patients showed a pattern of chronic inflammation with no signs suggestive of Crohn's disease at histology. Eleven out of 16 subjects underwent other diagnostic tools (upper GI endoscopy and/or bowel ultrasound and/or video-capsule endoscopy) and no pathologic findings were identified. In the remaining 5 a “wait and see” approach was adopted. Seven out of 16 subjects have a colonoscopy repeated during a median follow-up of 16 months (range 4–48): in 5 patients no endoscopic nor histologic changes were observed. In contrast, in 2 patients, both with ulcers at first colonoscopy, a conclusive diagnosis of ileal Crohn's disease was formulated, after 10 and 9 months, respectively. The other patients remain pauci- or a-symptomatic.

Conclusions: A small proportion of patients with occasionally observed ileitis is labelled as affected by Crohn's disease, while the vast majority remains without a definitive diagnosis. The clinical relevance of these findings remains to be established and prospective studies are warranted in order to provide a better definition of this nosological entity.