How does a biopsy of endoscopically normal terminal ileum contribute to the diagnosis? Which patients should undergo biopsy?

Figures & data

Fig. 1 Endoscopic appearance of normal terminal ileum.

Fig. 2 Aphthous ulcers on terminal ileum.

Table 1 Distribution of patients according to the indication and frequency of terminal ileitis

Indication	Total investigated, n (%)	Chronic ileitis, n (%)
Anemia	44 (14.8)	12 (27.3)*
Chronic diarrhea	103 (34.7)	10 (9.7)
Chronic diarrhea+ abdominal pain	55 (18.5)	15 (27.3)*
Abdominal pain	22 (7.4)	1 (4.5)
Radiologic finding	18 (6.0)	2 (11.1)
Control	32 (10.8)	2 (6.3)
Known IBD	23 (7.8)	7 (30.4)*
Total	297 (100.0)	49 (16.5)

Histopathological chronic ileitis was more frequent in anemia, chronic diarrhea + abdominal pain, and known IBD groups (*p<0.01).

IBD, inflammatory bowel disease.

Fig. 3 Histopathological results of biopsies from endoscopically normal terminal ileum according to indication.

Table 2 Pathology results of biopsies from endoscopically normal terminal ileum according to indication

		Pathology
		Normal		Lymphoid hyperplasia		Other		Chronic ileitis
Indication	n	n	%	n	%	n	%	n	%
Anemia	21	15	71.4	3	14.3	1	4.8	2	9.5*
Chronic diarrhea	85	74	87.1	8	9.4	0	0.0	3	3.5
Chronic diarrhea + abdominal pain	26	18	69.2	6	23.1	0	0.0	2	7.7*
Abdominal pain	17	12	70.6	2	11.8	2	11.8	1	5.9
Radiologic finding	13	8	61.5	3	23.1	2	15.4	0	0.0
Control	25	21	84.0	3	12.0	0	0.0	1	4.0
Known IBD	13	8	61.5	2	15.4	1	7.7	2	15.4*
Total	200	156	78.0	27	13.5	6	3.0	11	5.5

Chronic ileitis was more frequent in anemia, chronic diarrhea + abdominal pain, and known IBD groups (*p<0.05).

IBD, inflammatory bowel disease.

Fig. 4 Histopathological results of biopsies from aphthous ulcer group according to indication.

Table 3 Pathology results of biopsies from terminal ileum with aphthous ulcer according to indication

		Pathology
		Normal		Lymphoid hyperplasia		Other		Chronic ileitis
Indication	n	n	%	n	%	n	%	n	%
Anemia	23	7	30.4	2	8.7	4	17.4	10	43.5
Chronic diarrhea	18	7	38.9	0	0.0	4	22.2	7	38.9
Chronic diarrhea + abdominal pain	29	9	31.0	0	0.0	7	24.1	13	44.8
Abdominal pain	5	0	0.0	3	60.0	2	40.0	0	0.0
Radiologic finding	5	1	20.0	1	20.0	1	20.0	2	40.0
Control	7	4	57.1	0	0.0	2	28.6	1	14.3
Known IBD	10	4	40.0	1	10.0	0	0.0	5	50.0
Total	97	32	33.0	7	7.2	20	20.6	38	39.2

Table 4 Comparison of the laboratory data according to the endoscopic finding

	Normal terminal ileum, n=200	Aphthous ulcer, n=97
	Mean±SD	Mean±SD	p
WBC	7,096±2,287	8,430±2,933	<0.001
Hematocrit	39.4±6.2	39±5.4	0.65
Platelet	259,140±87,424	299,048±105,937	0.002
MCV	82.5±8.3	83.5±6.8	0.35
MPV	10.1±1.01	9.9±0.7	0.07
CRP	10.3±22.6	19.9±31.8	0.015
ESR	17.9±22.9	27.04±18.8	0.016
Albumin	4.4±0.4	4.1±0.5	0.01
Ferritin	76.2±205.4	99.7±252	0.53
Vitamin B12	317±228	243.2±105.6	0.03

CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; MCV, mean corpuscular volume; MPV, mean platelet volume; SD, standard deviation; WBC, white blood cell count.

Table 5 Comparison of laboratory data according to the histopathological results

	Normal histopathology, n=188	Chronic ileitis, n=49
	Mean±SD	Mean±SD	p
WBC	7,312±2,507	8,452±3,068	0.012
Hematocrit	39.8±6.2	39±5.8	0.470
Platelet	260,341±86,777	321,977±117,705	<0.001
MCV	82.3±8.8	82.9±5.4	0.550
MPV	10.2±0.8	9.4±0.6	<0.001
CRP	9.3±19.87	17.2±27.0	0.057
ESR	16±19.9	28.6±31.2	0.020
Albumin	4.4±0.4	4.1±0.6	0.051
Ferritin	74.2±214	59.9±78.7	0.730
Vitamin B12	316.2±225.8	246.1±163.8	0.100

CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; MCV, mean corpuscular volume; MPV, mean platelet volume; SD, standard deviation; WBC, white blood cell count.