Sachar David B
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Curr Gastroenterol Rep. 2018 Aug 6;20(9):43. doi: 10.1007/s11894-018-0651-8.
Not all injuries of the terminal ileum are Crohn's disease. It is the purpose of this review to consider the differential diagnosis of other acute and chronic ileal lesions.
The recognition of a granulomatous disease of the terminal ileum, distinct from tuberculosis, dates back over 85 years and perhaps much farther, but over the past decades, many other clinical pathologic entities have been described that are neither tuberculosis nor Crohn's eponymous regional enteritis. In recent years, the catalog of lesions mimicking Crohn's disease of the small bowel and proposals for differential diagnosis and treatment have expanded to include newly reported appendiceal pathology, primary cancers and lymphomas of the intestine, unexpected metastases from distant organs, unusual infections, vasculitides and other ischemic conditions, Behçet's disease, endometriosis, and drug reactions. A diagnosis of Crohn's disease should not be a reflex action in the face of small bowel structural or inflammatory lesions without consideration of pathology in adjacent organs, primary and metastatic lesions of the small intestine, infections, vascular diseases, infiltrative diseases, drug injury, or other "idiopathic" conditions.
并非所有回肠末端损伤都是克罗恩病。本综述旨在探讨其他急慢性回肠病变的鉴别诊断。
回肠末端存在一种不同于结核病的肉芽肿性疾病，这一认识可追溯到85年多前，甚至可能更早，但在过去几十年里，又描述了许多其他临床病理实体，它们既不是结核病，也不是克罗恩病所指的局限性肠炎。近年来，模仿小肠克罗恩病的病变目录以及鉴别诊断和治疗建议不断扩充，包括新报道的阑尾病理、肠道原发性癌症和淋巴瘤、远处器官意外转移瘤、不寻常感染、血管炎及其他缺血性疾病、白塞病、子宫内膜异位症和药物反应。面对小肠结构性或炎性病变时，若不考虑相邻器官的病理情况、小肠原发性和转移性病变、感染、血管疾病、浸润性疾病、药物损伤或其他“特发性”情况，就不应不假思索地诊断为克罗恩病。
