Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Akademisches Lehrkrankenhaus der Universität Hamburg, Hamburg, Germany.
Curr Opin Gastroenterol. 2019 May;35(3):213-222. doi: 10.1097/MOG.0000000000000522.
Increasing use of small bowel endoscopy unravels ulcers in a relevant number of patients. Although often attributed to inflammatory bowel disease (IBD), these ulcers may be unspecific or caused by a variety of other diseases. This review summarizes the recent literature related to differential diagnosis of small bowel ulcers.
NSAID enteropathy is the major differential diagnosis to IBD in patients with small bowel ulcers. Intestinal tuberculosis must be considered in patients at risk. Rare causes for small bowel ulcers are autoinflammatory, neoplastic, vascular diseases, or nontuberculous infections. Morphology of small bowel ulcers cannot provide a reliable differentiation, and even histology is not specific in all cases. History with special focus on NSAID medication and clinical symptoms not typical for IBD, laboratory tests in the search of systemic disease, and microbiologic testing of biopsies can be helpful. Genetic testing allows identification of few rare entities like defects in prostaglandin metabolism.
Due to a massive overlap in the endoscopic appearance of small bowel ulcers between possible causes, diagnosis should be based on broad information also including history, histology, imaging, and laboratory tests.
小肠内镜的广泛应用使很多患者的溃疡得到确诊。虽然这些溃疡通常归因于炎症性肠病（IBD），但也可能是非特异性的，或者由多种其他疾病引起。本文总结了与小肠溃疡鉴别诊断相关的最新文献。
在小肠溃疡患者中，非甾体抗炎药相关性肠病是 IBD 的主要鉴别诊断。有小肠溃疡风险的患者必须考虑肠结核。小肠溃疡的罕见病因包括自身炎症性疾病、肿瘤性疾病、血管性疾病或非结核性感染。小肠溃疡的形态不能提供可靠的鉴别诊断，即使组织学在所有情况下都不具有特异性。关注特殊的用药史、非 IBD 典型的临床症状、寻找系统性疾病的实验室检查以及活检的微生物学检查可能会有帮助。基因检测可以识别少数罕见疾病，如前列腺素代谢缺陷。
由于可能导致小肠溃疡的原因在内镜表现上有很大的重叠，因此诊断应基于广泛的信息，包括病史、组织学、影像学和实验室检查。
