title: Frequency, natural course and clinical significance of symptomatic terminal ileitis.
abstract: OBJECTIVE
  Treatment guidelines for managing symptomatic terminal ileitis (TI) are lacking. We followed up a cohort of symptomatic TI patients to conduct an algorithm for their management.
  
  
  METHODS
  Consecutive patients with symptomatic TI from July 2007 to October 2013 were included. Symptomatic TI was defined as isolated terminal ileum ulceration (superficial or deep) and/or nodularity with abdominal symptoms. Patients were diagnosed either with intestinal tuberculosis (ITB) or Crohn's disease (CD) using standard criteria or received only symptomatic treatment according to their clinical manifestations, endoscopic, imaging and histological (specific to ITB/CD vs non-specific) features. Based upon above findings, an algorithm was conducted to differentiate non-specific TI from those with specific etiology (ITB/CD).
  
  
  RESULTS
  In all, 63/898 (7.0%) patients with ulcero-constrictive intestinal disease had TI, of which 45 (26 males and 19 females) were included. Fever, diarrhea, weight loss, deep ulcers, and ileal thickening were more frequently observed in patients with ITB or CD having specific treatments compared with those receiving symptomatic treatments. All patients with deep ulcers and those with superficial ulcer and specific histology had ITB/CD. In patients with superficial ulcers and/or nodularity and non-specific inflammation (n = 31), the absence of fever, diarrhea, GI bleeding or weight loss had a negative predictive value of 92% in excluding ITB/CD.
  
  
  CONCLUSIONS
  In symptomatic TI patients with superficial ulcers and a non-specific histology, the absence of fever, diarrhea, GI bleeding or weight loss rules out the possibility of significant diagnoses like ITB/CD.
authors.affiliation: Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kedia
authors.affiliation: Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Lalit
authors.initials: L
authors.lastname: Kurrey
authors.affiliation: Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Venigalla
authors.initials: V
authors.lastname: Pratap Mouli
authors.affiliation: Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajan
authors.initials: R
authors.lastname: Dhingra
authors.affiliation: Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Srivastava
authors.affiliation: Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Pradhan
authors.affiliation: Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Raju
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Prasenjit
authors.initials: P
authors.lastname: Das
authors.affiliation: Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Veena
authors.initials: V
authors.lastname: Tiwari
authors.affiliation: Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Govind
authors.initials: G
authors.lastname: Makharia
authors.affiliation: Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vineet
authors.initials: V
authors.lastname: Ahuja
mesh_terms: D000328:Adult; D000465:Algorithms; D003113:Colonoscopy; D003424:Crohn Disease / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D003937:Diagnosis, Differential; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007079:Ileitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D009626:Terminology as Topic; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis; D055815:Young Adult
keywords: Crohn's disease; intestinal tuberculosis; terminal ileitis