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Biopsies of the Terminal Ileum in Inflammatory Bowel Diseases

2004; Volume: 9; Issue: 3 Linguagem: Inglês

10.1097/01.pcr.0000126996.04812.7b

1533-4015

Henry D. Appelman,

Gastrointestinal disorders and treatments

Biopsies of the terminal ileum for inflammatory bowel disease do indeed help when they have diagnostic features of chronic inflammation, a finding limited to patients with suspected Crohn disease with infrequent exceptions. In these patients, microscopic chronic disease establishes the terminal ileum as an important site of disease. Normal terminal ileal biopsies in patients in whom Crohn disease is a clinical consideration are also useful in helping to exclude Crohn disease. Ulcerative colitis can occasionally extend into the terminal ileum, but that is not an important part of the disease. Chronic ulcers resulting from ischemia and nonsteroidal anti-inflammatory drugs also occur in the TI and can mimic Crohn ulcers. In our experience, biopsies of endoscopically normal terminal ileum are hardly ever abnormal microscopically, even in patients in whom Crohn disease is part of the clinical differential diagnosis. In contrast, the highest yield of biopsies with chronic inflammatory features is when there is endoscopically abnormal terminal ileal mucosa.