BACKGROUNDIleocecal ulcers can be caused by various kinds of diseases.Besides inflammatory intestinal disease(IBD),Inflammation,infections,tumors,drug factors and some systemic diseases can also cause ileocecal ulcers.Presently,the diagnosis of ileocecal ulcers mainly depends on endoscopy and pathological biopsy.However,many diseases lack specific endoscopic manifestations and the endoscopic characteristics of different diseases may be similar.At the same time,mucosal biopsy is limited by the inability to detect transmural intestinal disease and it is difficult to get meaningful pathological results with only one endoscopy,the diagnosis of ileocecal ulcers is sometimes difficult.If the patient’s initial pathological biopsy showed non-specific pathological changes,how to perform next examination,treatment or follow-up,there is still no consensus.Previously,a large number of studies about ileocecal ulcers have focused on Crohn’s disease(CD),however,ileocecal ulcers can be caused by various kinds of diseases and not all ileocecal ulcers are CD.Presently,the research about the causes of ileocecal ulcers is still rare.At the same time,we need to have a small intestinal examination to know whether the ileocecal ulcers,especially the terminal ileum ulcers,is an isolated lesion.However,it is still difficult to determine whether there is a small intestinal disease in patients with ileocecal ulcers by traditional examination methods.Nowadays capsule endoscopy(CE)and balloon assisted enteroscopy(BAE)have played an important role in the detection of small intestinal lesions,but the research about small intestinal disease in patients with ileocecal ulcers is still rare.AIMThe purpose of this study is to summarize the cause of patients with ileocecal ulcers,describe the clinical features of different ileocecal ulcers,analyze the value of pathological examinations and related auxiliary examinations in the diagnosis and differential diagnosis of ileocecal ulcers,evaluate the small intestinal lesions of patients with ileocecal ulcers and summarize the types of small intestinal lesions.We hope to provide help for the diagnosis and differential diagnosis of ileocecal ulcers.Research objects and methodsWe retrospectively collected the clinical data,including demographics data,clinical symptoms,concomitant diseases,medication history,laboratory tests,imaging tests,colonoscopy and pathological biopsy results,capsule endoscopy and balloon assisted enteroscopy results,surgical records and surgical pathology results,final diagnosis from the inpatient with ileocecal ulcers who underwent colonoscopy at Qilu Hospital of Shandong University from January 2015 to December 2018.RESULTS1.Causes of ileocecal ulcers:Of the 174 patients with ileocecal ulcers,84 patients(48.3%,84/174)were diagnosed.Inflammatory intestinal disease(19.5%,34/174)is the most common cause,including 26 cases of CD and 8 cases of UC.Followed by neoplastic disease(13.8%,24/174),including 9 cases of colon cancer,10 cases of intestinal lymphoma,3 cases of small intestinal adenocarcinoma,1 case of small intestinal fibroma,and 1 case of appendiceal adenocarcinoma.14 infectious diseases(8.0%,14/174),including 10 cases of ITB,3 cases of pseudomembranous enteritis,and 1 case of cat scratch disease.Other causes include intestinal Behcet’s disease in 10 cases,NSAIDs-related enteritis in 1 case,and appendiceal abscess in 1 case.90 patients(51.7%,90/174)could not be diagnosed.2.Clinical features of patients with ileocecal ulcers:Of the 174 patients with ileocecal ulcers,the average age was 46.3±15.2 years,and the male to female ratio was 1.8:1;abdominal pain(69.0%)is the most common gastrointestinal symptom and weight loss(35.1)%is the most common non-digestive symptom;Ulcers vary in size and shape,and ulcers are most common in ileum alone(47.1%)and multiple ulcers(68.4%),which can be accompanied by colon ulcers(21.3%).3.Pathological diagnosis results of ileocecal ulcers:Only 31(17.8%,31/174)patients showed specific pathological changes in the initial endoscopic pathological biopsy.The remaining 143 patients only showed non-specific pathological changes,including acute and chronic inflammation,mucosal edema,cryptitis,inflammatory cell infiltration and ulcer formation.Colonoscopy was reviewed in 101 of 143 patients and specific pathological changes were obtained in 11 patients.14 patients were diagnosed by surgical operation and 1 patient was diagnosed by lymph node aspiration.4.Small intestinal lesions in patients with ileocecal ulcers:75 patients with ileocecal ulcers performed small intestinal endoscopy,including 15cases of capsule endoscopy,54 cases of antegrade enteroscopy and 64 cases of retrograde enteroscopy.47(62.7%,47/75)patients found small intestinal lesions beyond the terminal ileum.small intestinal ulcers are the most common small intestinal lesions and CD is the most common diagnosis of small intestinal ulcers.Other small intestinal lesions include lymphangiectasis,vascular malformations,Meckel’s diverticulum,mucosal bulges,submucosal bulges,and hyperemic edema.There were no statistical differences between the small intestinal ulcer group and the non-intestinal ulcer group in terms of gender,age,and imaging characteristics.Multiple ulcers were more common in the small intestinal ulcer group(P=0.044).Increased ESR(P=0.041)and elevated CRP(P=0.01)were more common in the small intestinal ulcer group.5.Comparison of CD with ITB,intestinal lymphoma and intestinal Behcet’s disease:Comparison of CD and ITB,the positive rate of T-spot test of ITB patients was significantly higher than those of CD patients(P<0.001),Comparison of CD and intestinal lymphoma,abdominal pain(P=0.01)and weight loss(P=0.025)were more common in patients with CD and fever was more common in patients with intestinal lymphoma(P=0.015).Comparison of CD and intestinal Behcet’s disease,patients in intestinal Behcet’s disease were younger than patients in CD.Oral ulcers(P<0.001)and fever(P=0.015)were more common in patients with intestinal Behcet’s disease.CONCLUSION1.The causes of ileocecal ulcers are diverse.Among patients with definite diagnosis,inflammatory intestinal disease is the main cause.CD is the most common cause of inflammatory intestinal disease.Other common causes include neoplastic and infectious diseases.Intestinal lymphoma is the most common cause of neoplastic disease,and ITB is the most common cause of infectious diseases.2.Pathological biopsy plays an important role in the diagnosis of ileocecal ulcers,but it is limited by the inability to detect transmural intestinal disease.The diagnostic value of pathological biopsy is limited in ileocecal ulcers.Some patients were diagnosed by surgery operation or long-term treatment follow-up.In the process of pathological biopsy,we should pay attention to multi-point and multi-segment biopsy and pay attention to deep sampling.Multiple biopsies are helpful for diagnosis.3.Patients with ileocecal ulcers may also have small intestinal lesions and small intestinal ulcers are the most common small intestinal lesions.Compared with patients in the non-small intestinal ulcer group,multiple ulcers,increased ESR and increased CRP were common in the mall intestinal ulcer group.CE and BAE play an important role in the detection of small intestinal lesions.We should comprehensively evaluate the clinical characteristics of the patients and perform intestinal endoscopy on ileocecal ulcer patients.4.The diagnosis of some ileocecal ulcers is difficult,we should attach importance to the role of multi-disciplinary team in the diagnosis of ileocecal ulcers.At the same time,we should attach importance to the role of auxiliary examinations in the differential diagnosis of diseases,T-spot test helps differential diagnosis of CD and ITB.Finally,we should pay attention to the long-term follow-up of patients.If diagnosis is difficult,the diagnostic treatment should be considered. |