title: Clinical utility of retrograde terminal ileum intubation in the evaluation of chronic non-bloody diarrhea.
abstract: OBJECTIVE
  The aims of this study were to investigate the frequency and factors involved in the terminal ileum intubation of patients with chronic, non-bloody diarrhea and to compare diagnostic yields of colonoscopy and ileocolonoscopy.
  
  
  METHODS
  The medical records of 945 patients undergoing colonoscopy for chronic, non-bloody diarrhea were reviewed. Findings of microscopic colitis, Clostridium difficile colitis, celiac disease, inflammatory bowel disease or tropical sprue were considered as definitive causes of diarrhea.
  
  
  RESULTS
  A total of 689 patients met the diagnosis of chronic, non-bloody diarrhea, in which 370 (53.7%) underwent ileocolonoscopy. Specific histological diagnosis could explain the patient's symptoms in 107 (15.5%) patients. The diagnostic yield were 15.0% in the colonoscopy-only group, 16.9% in the ileocolonoscopy without biopsy group, and 15.5% in the ileocolonoscopy with biopsy group. Of the 19 patients with an abnormal terminal ileal biopsy, six (31.6%) had an otherwise normal colonic appearance which would have been diagnosed as normal if the ileum had not been reached and biopsied. In those with Crohn's disease (n = 7), five had ileocolitis and two had colitis only. A multivariate analysis showed that age of the patients and otherwise normal gross endoscopic results to be the only factors associated with a lower likelihood of ileal intubation by endoscopists.
  
  
  CONCLUSIONS
  The ileal intubation rate was 53.7% in our patients with chronic, non-bloody diarrhea. Diagnostic yield of ileocolonoscopy with biopsy in US patients with chronic, non-bloody diarrhea appeared to be low, if the colon side was normal on endoscopy. But this may provide supportive evidence in patients diagnosed with ileocolonic Crohn's disease.
authors.affiliation: Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Makkar
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis; D002908:Chronic Disease; D003092:Colitis / Q000150:complications / Q000175:diagnosis; D003106:Colon / Q000473:pathology; D003113:Colonoscopy / Q000379:methods; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis; D003967:Diarrhea / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology*; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000175:diagnosis; D007441:Intubation, Gastrointestinal / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged
keywords: Crohn's disease; colonoscopy; diarrhea; ileocolitis; ileocolonoscopy