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MICROSCOPIC ILEITIS CLINICALLY RELEVANT OR NOT STUDY (MICRONS)
N Arya, K Madala, I Prokopiw, T Ponich, CA McLean, DK Driman, JC Gregor
Department of Medicine (Gastroenterology) and Pathology, University of Western Ontario, London, Ontario
BACKGROUND: Endoscopic visualization and pathologic correlation is generally accepted to be the gold standard for the diagnosis of Crohn’s disease. Examination of the terminal ileum at the time of colonoscopy is becoming more frequent and routine. Whether biopsy of a normal appearing terminal ileum has any diagnostic value is uncertain. This study will attempt to determine the universal application of terminal ileum biopsy in a non-specific group of symptomatic patients undergoing the procedure.
METHODS: Consecutive patients who underwent colonoscopy for abdominal symptoms were compared with asymptomatic patients colonoscoped for cancer surveillance. Symptoms included pain, diarrhea, and hematochezia. All patients with pre-existing inflammatory bowel disease or who had surgical resection of the terminal ileum were excluded. Colonoscopy was performed by one of three experienced gastroenterologists. Two biopsies were obtained from each patient after successful intubation of the terminal ileum. Both biopsies were reviewed blindly by two independent, experienced GI pathologists. Diagnoses were limited to suggestive of Crohn’s disease, non-specific ileitis and no pathologic disease.
RESULTS: A total of 193 patients were entered into the study. Intubation and biopsy were successful in 180(93.2%). In the biopsies reviewed; 119 patients were symptomatic (group 1), and 61 were asymptomatic (group 2). The terminal ileum had a normal endoscopic appearance in 87 patients in group 1 and 51 patients in group 2. Only 14 patients (16%) from group 1 who had normal endoscopy of the terminal ileum had microscopic ileitis compared to 7 patients (14%) from group 2. This was not statistically significant, with a p-value of 0.9. In all patients, 25% of symptomatic patients had abnormal biopsies in the terminal ileum compared to 18% in the asymptomatic group; not statistically significant (p-value of 0.37).
CONCLUSION: Although routine intubation of the terminal ileum may be helpful in diagnosing Crohn’s disease, biopsy of a normal appearing terminal ileum does not appear to be rational. The long-term relevance of those with microscopic ileitis still needs further study.