Etiology and Management of Terminal Ileal Ulcers
Common Etiologies
- The primary etiology of terminal ileal ulcers in India is intestinal tuberculosis, followed by Crohn's disease, non-specific ulcers, and infectious causes, according to the International Journal of Infectious Diseases 1
- Intestinal tuberculosis typically affects the ileocecal region and terminal ileum with characteristic features including circumferential ulcers, strictures, and occasionally perforation 1
- Other infectious causes include Yersinia, Salmonella, Shigella, and Campylobacter species, which can cause acute terminal ileitis that may resolve with appropriate antimicrobial therapy 2
- Crohn's disease is the second most common cause of terminal ileal ulcers in India, characterized by transmural inflammation, skip lesions, and granulomas on histopathology 2
- Ulcerative colitis with "backwash ileitis" can present with terminal ileal ulcers in approximately 20% of patients with extensive colitis, showing continuous inflammation extending from the colon 3, 2
Diagnostic Approach
- Ileocolonoscopy with multiple biopsies is the gold standard for diagnosis of terminal ileal ulcers, as recommended by Praxis Medical Insights 2
- Endoscopic features that suggest Crohn's disease include aphthous ulcers, longitudinal ulcers, and cobblestone appearance 3, 2
- Histopathological features of tuberculosis include large granulomas, often multiple and confluent, with caseous necrosis and presence of acid-fast bacilli 1
- Histopathological features of Crohn's disease include focal chronic inflammation, transmural involvement, small non-caseating granulomas, and crypt architectural distortion 3, 2
Management Considerations
- For confirmed tuberculosis, standard anti-tubercular therapy for 6-9 months is recommended by the International Journal of Infectious Diseases 1
- For Crohn's disease, treatment options include 5-ASA compounds, immunomodulators, and biologics depending on disease severity, as recommended by the Journal of Crohn's and Colitis 5
- Stool cultures for other infectious causes should be performed, especially in acute presentations, according to Gut 4, 2