Kim Woo Jin, Lee Cheol Min, Jang Jin Ook, Kim Su Jin, Choi Cheol Woong, Park Su Bum
Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Medicine (Baltimore). 2025 May 9;104(19):e42432. doi: 10.1097/MD.0000000000042432.
Despite advancements in diagnostic techniques, the accurate identification and management of localized terminal ileitis or ulcers (LTIU) remains challenging, with a wide range of associated diseases presenting with similar clinical and endoscopic features. This retrospective observational study aimed to determine the etiology and discrimination of various diseases in patients with symptomatic LTIU. Data on demographics, clinical manifestations, and endoscopic findings were collected and analyzed statistically using descriptive and inferential methods, including frequency analysis and chi-square tests. Among the 224 patients who underwent LTIU on ileocolonoscopy, 110 (49.1%) had symptoms, of which 71 (64.5%) had specific etiologies on initial testing and after 6 months of follow-up. Definitive diagnoses were ascertained, with Crohn disease (CD) and Behçet disease (BD) being the most common diseases in this cohort, accounting for 27.3% (30 patients) and 18.2% (20 patients) of cases, respectively. Other diagnoses included infectious enteritis in 10 (9.1%) patients, drug-induced enteropathy in 5 (4.5%), intestinal tuberculosis in 5 (4.5%), and lymphoma in 1 (0.9%). Additionally, 39 patients (35.5%) had nonspecific ulcers. After 1 year of treatment, symptomatic and endoscopic resolution was noted in 7 out of 30 patients (23.3%) with CD and 10 out of 20 (50.0%) with BD. Of the 39 patients initially diagnosed with nonspecific ulcers with persistent symptoms, 2 were eventually diagnosed with CD. The high proportion of diagnosed diseases among symptomatic patients with LTIU underscores the importance of early and accurate diagnosis in guiding appropriate treatment strategies. These findings highlight the need for further research to refine diagnostic approaches and optimize patient outcomes in this challenging clinical scenario.
尽管诊断技术有所进步，但准确识别和管理局限性回肠炎或溃疡（LTIU）仍然具有挑战性，因为多种相关疾病具有相似的临床和内镜特征。这项回顾性观察性研究旨在确定有症状的LTIU患者中各种疾病的病因及鉴别诊断。收集了人口统计学、临床表现和内镜检查结果的数据，并使用描述性和推断性方法进行统计学分析，包括频率分析和卡方检验。在224例行回结肠镜检查诊断为LTIU的患者中，110例（49.1%）有症状，其中71例（64.5%）在初始检查及6个月随访后有明确病因。确定了明确诊断，克罗恩病（CD）和白塞病（BD）是该队列中最常见的疾病，分别占病例的27.3%（30例）和18.2%（20例）。其他诊断包括10例（9.1%）感染性肠炎、5例（4.5%）药物性肠病、5例（4.5%）肠结核和1例（0.9%）淋巴瘤。此外，39例患者（35.5%）有非特异性溃疡。治疗1年后，30例CD患者中有7例（23.3%）症状和内镜表现缓解，20例BD患者中有10例（50.0%）缓解。在最初诊断为非特异性溃疡且症状持续的39例患者中，有2例最终被诊断为CD。有症状的LTIU患者中确诊疾病的比例较高，这凸显了早期准确诊断对指导适当治疗策略的重要性。这些发现强调了在这一具有挑战性的临床情况下，需要进一步研究以完善诊断方法并优化患者预后。
