title: Does the endoscopic appearance of the ileocecal valve suggest the severity of Crohn's disease in the terminal ileum?
abstract: Despite ileoscopy being the only procedure, which can accurately detect mucosal abnormalities in the ileum, it is performed only in 5-15% of the colonoscopies.
  
  
  OBJECTIVE
  The aim of this study was to retrospectively determine the predictive value of the endoscopic findings of the ileocecal valve (ICV) in patients with CD.
  
  
  METHODS
  Data of 100 ileal or ileocolonic CD patients (45 females, 55 males, mean age 27.6 years, range 5-66), who underwent ileocolonoscopy between 2004 and 2008, were reviewed. Macroscopic appearance of the ICV and the endoscopic severity of the ileum evaluated by the Simple Endoscopic Score for Crohn's Disease were determined by re-evaluating the examinations recorded on DVDs in all cases. Histological scoring was performed in 56 cases. Statistical analyses were performed to assess relationships between the normal-looking ICV and the histological and endoscopic scores of the ileum and the correlation between the severity of the ileal inflammation and the macroscopic appearance of the ICV.
  
  
  RESULTS
  A macroscopically normal appearance of the ICV was detected in 30 patients. 60% of these patients were diagnosed with mild, 26.7% with moderate and 13.3% with severe endoscopic ileal inflammation. ICV was affected by CD in 70 patients, in whom significantly more severe ileal inflammation (p=0.005) was detected than in patients with normal-looking ICV.
  
  
  CONCLUSIONS
  Our results suggest that ileal exploration should be attempted in every suspected CD patients, because, although the appearance of the ICV correlates with the severity of the ileal inflammation, a normal-looking ICV does not correspond to normal ileal mucosa in almost one third of the cases.
authors.affiliation: First Department of Medicine, University of Szeged, H-6720, Korányi fasor 8, Szeged, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Molnár
authors.forename: Klaudia
authors.initials: K
authors.lastname: Farkas
authors.forename: Ferenc
authors.initials: F
authors.lastname: Nagy
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szepes
authors.forename: László
authors.initials: L
authors.lastname: Tiszlavicz
authors.forename: István
authors.initials: I
authors.lastname: Németh
authors.forename: Tibor
authors.initials: T
authors.lastname: Nyári
authors.forename: Tibor
authors.initials: T
authors.lastname: Wittmann