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P129. Terminal ileitis - Is it Crohn's disease?

T. Pinto-Pais, C. Fernandes, I. Ribeiro, S. Fernandes, J. Fraga, J. Carvalho, Centro Hospitalar de Gaia/Espinho, Gastroenterology, Gaia, Portugal

Background

Terminal ileitis (TI), defined as inflammation of the terminal ileum, is a common condition in clinical practice, and is classically associated to Crohn's disease (CD). However, a wide variety of diseases may be associated with ileitis. The diagnosis of the specific cause of ileitis is of paramount importance because misdiagnosis may result in delays or errors in patient management.

We aimed to study the group of patients with confirmed diagnosis of TI admitted to our department between January 2009 and February 2013.

Methods

An observational, descriptive longitudinal study was performed, with retrospective review of demographics, clinical presentation, laboratory data, treatment and follow-up. The diagnosis of CD was obtained by ileocolonoscopy and biopsies, either on an inpatient or outpatient basis. The infectious etiology was presumed when there was clinical, analytical and imaging remission after empirical antibiotic therapy, or confirmed by isolation of pathogenic microorganisms in stool cultures.

Results

This study assessed sixty-two patients, 38.2 years median age (18–82), and a slight predominance of females (56.4%). The diagnosis of TI was performed by abdominal ultrasound in all patients, and confirmed by Computed Tomography in 62.9%. The main form of presentation was abdominal pain (93.5%) and diarrhea (67.7%). In this study, infectious etiology was considered in 62.9% (39/62) of patients, CD diagnosed in 32.2% (n = 20) and ileum cancer in 4.9% (ileal lymphoma - 2, adenocarcinoma - 1). Fecal pathogens were identified in 7 patients: Campylobacter - 3, Yersinia - 2 and Salmonella - 2. No parasitic or tuberculosis infection were identified. In comparative analysis between the group with CD and infectious ileitis, we found in the first group higher median values of serum inflammatory parameters (C-reactive protein of 9.8 vs 7.4 mg/dL; Leukocyte count of 16,650 vs 11,170/uL) and lower hemoglobin (10.45 vs 13.5 g/dL), as well as longer inpatient period (10 vs 5 days). Patients diagnosed with CD maintain long-term follow-up in our outpatient clinic.

Conclusion

The diagnosis of Crohn's disease of the ileum was performed in 32.2% of patients with terminal ileitis. We highlight that infectious etiology is a common cause of ileum inflammation (62.9% of our study), and the importance in the differential diagnosis of this entity.