Isolated Ileitis in Children

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A Alper et al. JPGN 2023; 76: 338-342. Isolated Terminal Ileitis in Children

This single center retrospective study reviewed 640 colonoscopies in symptomatic children.

Key findings:

  • Thirty-three children had isolated histologically-defined terminal ileitis. Seventeen children were diagnosed with CD and 18 children had idiopathic terminal ileitis (3 lost to followup)
  • Children with CD had higher prevalence of abnormal C-reactive protein levels, severe inflammation, and radiological evidence of bowel wall thickening compared with children with idiopathic ileitis.
  • Two children with idiopathic ileitis were later diagnosed with CD; the remaining 13 did not develop CD over a follow-up period of 83 months.
  • From the data presented, it appeared that the center had a low rate of ileal intubation (316 colonoscopies were excluded for this reason)
  • 75% of those with histologic ileitis had normal endoscopic appearance

When our group looked at colonoscopies (n=374) in our outpatient endoscopy center, we identified isolated ileitis in 10% (6% grossly abnormal, 4% with only histologically abnormal) (related blog post: Our Study: Provider Level Variability in Colonoscopy Yield). Higher rates of ileal intubation (90% in our study) should be considered a quality metric given that 5-10% of children may have disease isolated in ileum.

My take: This study provides reassurance that most children with histologic ileitis will not progress to CD if the ileum is visually-normal (in the absence of abnormal blood tests and/or imaging).

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Chattahoochee River, Sandy Springs, GA