Etiology of isolated terminal ileal ulcers in symptomatic patients

  • Suresh Thapa National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • Binod Karki National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • Dibas Khadka National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • Sanjit Karki National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • Roshan Shrestha National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • Jiwan Thapa National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • Shankar Baral National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • Bhuwneshwer Yadav National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • Ramila Shrestha National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • Bidhan Nidhi Poudel National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
Keywords: Colonoscopy, intestinal tuberculosis, Isolated terminal ileal ulcer, Crohn's disease

Abstract

Introduction: Isolated terminal ileal ulcers (ITIUs) are being frequently encountered by the clinicians with the increasing numbers of ileal intubation during colonoscopies. This study was aimed at finding the etiologies of these ulcers in symptomatic patients and their association with various clinical features.

Methods: This was a hospital based prospective, observational, descriptive study performed on all consecutive patients who underwent ileocolonoscopy for various gastrointestinal symptoms between 1 July 2018 and 30 June 2019. Clinical, endoscopic and histopathological findings were analyzed to determine the etiology of ITIUs in symptomatic patients. Statistical analysis was done by SPSS 20.

Results: Among 60 (7.67%) of 782 symptomatic patients who had ITIUs on ileocolonoscopy, specific etiologies were established in 28 (46.67%) of them. Intestinal TB was the most common specific diagnosis, which was seen in 18 (30%) patients. Chronic abdominal pain with or without chronic diarrhea was the most common indication for ileocolonoscopy.

Conclusions: Specific etiologies like tuberculosis, Crohn’s disease, NSAID-induced ulcer and intestinal spirochetosis were seen in 28 (46.67%) of patients with isolated terminal ileal ulcers. The most common clinical features were chronic abdominal pain (65%) and abdominal pain with diarrhea (16.7%). No clinical presentation was significantly associated with any specific etiology, thus emphasizing the need for routine ileal intubation and tissue sampling for histopathological examination in all symptomatic patients undergoing colonoscopy.

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Author Biographies

Suresh Thapa, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

DM Resident, Department of Gastroenterology

Binod Karki, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

DM Resident, Department of Gastroenterology

Dibas Khadka, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

DM Resident, Department of Gastroenterology

Sanjit Karki, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

DM Resident, Department of Gastroenterology

Roshan Shrestha, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

DM Resident, Department of Gastroenterology

Jiwan Thapa, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

DM Resident, Department of Gastroenterology

Shankar Baral, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

DM Resident, Department of Gastroenterology

Bhuwneshwer Yadav, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

DM Resident, Department of Gastroenterology

Ramila Shrestha, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

Professork, Department of Gastroenterology

Bidhan Nidhi Poudel, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

Professor, Department of Gastroenterology

Published
2019-09-05
How to Cite
Thapa, S., Karki, B., Khadka, D., Karki, S., Shrestha, R., Thapa, J., Baral, S., Yadav, B., Shrestha, R., & Poudel, B. (2019). Etiology of isolated terminal ileal ulcers in symptomatic patients. Nepal Journal of Medical Sciences, 4(2), 2-9. https://doi.org/10.3126/njms.v4i2.25471
Section
Original Articles