title: How does a biopsy of endoscopically normal terminal ileum contribute to the diagnosis? Which patients should undergo biopsy?
abstract: Terminal ileum endoscopy and biopsy are the diagnostic tools of diseases attacking the ileum. However, abnormal histological findings can be found in endoscopically normal terminal ileum.
  
  
  
  This study was performed to evaluate the histopathological results of biopsies from endoscopically normal terminal ileum in order to determine pre-procedure clinical and laboratory factors predicting abnormal histopathological results, if any.
  
  
  
  A total of 297 patients who underwent colonoscopy and terminal ileum biopsy and had normal terminal ileum or a few aphthous ulcers in the terminal ileum together with completely normal colon mucosa were included in the study. The patients were grouped into two arms as normal cases and cases with aphthous ulcers. Histopathological and pre-procedural laboratory results of patients were analyzed according to their indications.
  
  
  
  The terminal ileum was endoscopically normal in 200 patients, and 97 patients had aphthous ulcers. Chronic ileitis rate was present in 5.5% of those with endoscopically normal terminal ileum and in 39.2% of the patients with aphthous ulcers. In both groups, the highest rate of chronic ileitis was detected in the patients with known inflammatory bowel disease (IBD) (15.4 and 50%, respectively), anemia (9.5 and 43.5%, respectively), and in the patients having chronic diarrhea together with abdominal pain (7.7 and 44.8%, respectively). We found that the sensitivity of mean platelet volume for predicting chronic ileitis was 87% and the specificity was 45% at a cut-off value lower than 9.35 fl.
  
  
  
  In anemia indication or chronic diarrhea together with abdominal pain, the frequency of aphthous ulcers detected by ileoscopy and the frequency of chronic ileitis detected histopathologically despite a normal-appearing ileum were elevated.
authors.affiliation: Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey; arkoksal@gmail.com.
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Koksal
authors.affiliation: Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Salih
authors.initials: S
authors.lastname: Boga
authors.affiliation: Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Alkim
authors.affiliation: Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Meltem
authors.initials: M
authors.lastname: Ergun
authors.affiliation: Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Bayram
authors.affiliation: Department of Pathology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Damlanur
authors.initials: D
authors.lastname: Sakiz
authors.affiliation: Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Ozdogan
authors.affiliation: Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Engin
authors.initials: E
authors.lastname: Altinkaya
authors.affiliation: Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Canan
authors.initials: C
authors.lastname: Alkim
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000175:diagnosis; D001706:Biopsy; D002908:Chronic Disease; D003113:Colonoscopy; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology; D005260:Female; D006801:Humans; D007079:Ileitis / Q000175:diagnosis*; D007082:Ileum / Q000473:pathology*; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D013281:Stomatitis, Aphthous / Q000175:diagnosis*
keywords: Terminal ileum; chronic ileitis; ileoscopy; inflammatory bowel disease