title: [Diagnostic value of routine ileum biopsy in patients with chronic diarrhoea--a prospective monocentric study].
abstract: OBJECTIVE
  In patients with chronic diarrhoea of unknown origin, colonoscopy with intubation of the terminal ileum and performance of biopsies are standard in the diagnostic work-up. While the importance of random biopsies in the colon even in cases with normal endoscopic appearance has been proven in several studies, the role of biopsies in the terminal ileum under these circumstances is not well defined.
  
  
  METHODS
  In this prospective observational 24-month study patients with chronic diarrhoea of unknown cause were included. All patients underwent colonoscopy with intubation and biopsy of the terminal ileum. These biopsies have been analysed, their diagnostic value has been compared to the endoscopic appearance and the clinical diagnosis was investigated.
  
  
  RESULTS
  In 159 patients, the terminal ileum showed a pathological endoscopic appearance in 27 cases (17 %). In 22 (81.5 %) of these 27 patients diagnostic pathological findings were present, in 4 cases (14.8 %) non-specific histological changes were detected and in one patient (3.7 %), histology was normal. In contrast, only in one of 132 cases with normal endoscopic appearance, did histopathology show a significant pathology (celiac disease). In 30 of the 132 patients (22.7 %) with a normal endoscopic appearance, distinctive histological features were detected (slight eosinophilia or elevated mucosal immune cell count), but not classified as diagnostic. In all cases, these features were also present in simultaneously performed colonic biopsies.
  
  
  CONCLUSIONS
  Routine biopsy of the terminal ileum, when normal endoscopic appearance is documented, does not give any additional information and cannot be recommended as a standard procedure in endoscopic work-up of chronic diarrhoea.
authors: Klinik für Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin (Medizinische Klinik III), Universitätsklinikum Aachen, Medizinische Fakultät der RWTH, Aachen.
authors: H H
authors: HH
authors: Lutz
authors: Institut für Pathologie, Universitätsklinikum Aachen, Medizinische Fakultät der RWTH, Aachen.
authors: N
authors: N
authors: Gaßler
authors: Klinik für Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin (Medizinische Klinik III), Universitätsklinikum Aachen, Medizinische Fakultät der RWTH, Aachen.
authors: K
authors: K
authors: Streetz
authors: Klinik für Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin (Medizinische Klinik III), Universitätsklinikum Aachen, Medizinische Fakultät der RWTH, Aachen.
authors: G
authors: G
authors: Sellge
authors: Klinik für Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin (Medizinische Klinik III), Universitätsklinikum Aachen, Medizinische Fakultät der RWTH, Aachen.
authors: C
authors: C
authors: Trautwein
authors: Klinik für Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin (Medizinische Klinik III), Universitätsklinikum Aachen, Medizinische Fakultät der RWTH, Aachen.
authors: J J W
authors: JJ
authors: Tischendorf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002908:Chronic Disease; D003113:Colonoscopy; D003955:Diagnostic Tests, Routine; D003967:Diarrhea / Q000473:pathology*; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult