The clinical significance of focal enhanced gastritis in adults with isolated ileitis of the terminal ileum.
BACKGROUND
Isolated chronic ileitis in the terminal ileum, without accompanying chronic colitis, is not an uncommon finding present in biopsy specimens from patients being evaluated for chronic diarrhea. Among the many entities that should be included in the differential diagnosis are Crohn's disease and nonsteroidal antiinflammatory drugs (NSAIDs)-induced enterocolitis. In high-prevalence Crohn's disease populations, focal enhanced or active gastritis (FEG) may be a good predictor of Crohn's disease; however, this criterion may not apply in a general clinical setting. Our goal was to determine if FEG is a pathological marker of Crohn's disease in patients with isolated chronic ileitis in the terminal ileum.


METHODS
We examined 46 consecutive cases of isolated chronic ileitis with concurrent stomach biopsies. These patients did not have evidence or previous history of inflammatory bowel disease. The diagnostic criteria of chronic ileitis included crypt distortion and inflammation, plasmacytosis in the lamina propria, ulceration, and/or pyloric gland metaplasia.


RESULTS
Of the 46 cases reviewed, 25 (54%) cases were diagnosed with Crohn's disease later, confirmed by clinical manifestations and/or biopsies with a follow-up of up to 4 years. The stomach biopsies of these patients were either normal or demonstrated a spectrum of histological findings, including FEG, chronic gastritis with or without Helicobacter pylori organisms, chemical gastropathy, and normal tissues. FEG was more commonly present in Crohn's disease patients (36%) than in non-Crohn's disease patients (5%) (P < 0.01).


CONCLUSIONS
The presence of FEG is a good indicator for the diagnosis of Crohn's disease in adult patients with isolated chronic ileitis.
Petrolla
Amber A
AA
Department of Pathology, University Hospital Case Medical Center, Case Western Reserve University, 2103 Cornell Rd, 5525 WRB, Cleveland, OH 44106, USA.
Katz
Jeffry A
JA
Xin
Wei
W
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005756:Gastritis / Q000150:complications* / Q000473:pathology; D006801:Humans; D007079:Ileitis / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000473:pathology