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Chapter 19 - Jejunitis and Ileitis

Published online by Cambridge University Press:  06 June 2020

By
Karel Geboes  and
Anne Jouret-Mourin
Edited by
Roger M. Feakins
Roger M. Feakins
Affiliation:
Royal Free London NHS Foundation Trust, London, UK
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Summary

Infectious diseases of the lower gastrointestinal tract are caused by a vast array of viral, bacterial, fungal, and parasitic organisms. Pathologists are often called upon to distinguish infectious enterocolitis from other inflammatory disorders and, when possible, identify the causative pathogen or group of pathogens. Thus, pathologists should be aware of the patterns of injury and morphologic features that suggest infectious enterocolitides and should be able to generate a reasonable but narrow differential diagnosis that guides clinical management. This chapter reviews the clinical, gross, and, microscopic features of common and emerging infectious diseases of the lower gastrointestinal tract and emphasizes the pathologic findings that aid the appropriate classification of these diseases in daily practice.

Keywords

viralbacterialfungalparasiticenterocolitisdiarrheahistologygrossmicroscopicpathology
Type
Chapter
Information
Non-Neoplastic Pathology of the Gastrointestinal Tract
A Practical Guide to Biopsy Diagnosis
 , pp. 287 - 309
Publisher: Cambridge University Press
Print publication year: 2020

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References

Van Kruiningen, HJ, West, AB, Freda, BJ, et al. Distribution of Peyer’s patches in the distal ileum. Inflamm Bowel Dis. 2002;8:180–5.Google Scholar
Avansino, JR, Chen, DC, Hoagland, VD, et al. Treatment of bile acid malabsorption using ileal stem cell transplantation. J Am Coll Surg. 2005;201:710–20.CrossRefGoogle ScholarPubMed
Geboes, K, Van den Oord, JJ, Rutgeerts, P, et al. Immunohistochemical identification of lysozyme in pseudopyloric gland metaplasia in Crohn’s disease. Hepatogastroenterol. 1983;30:158–60.Google Scholar
Rubio, CA. The natural antimicrobial enzyme lysozyme is up-regulated in gastrointestinal inflammatory conditions. Pathogens. 2014;3:73–92.CrossRefGoogle ScholarPubMed
Gersemann, M, Stange, EF, Wehkamp, J. From intestinal stem cells to inflammatory bowel disease. World J Gastroenterol. 2011;17:3198–203.Google Scholar
Middendorp, S, Schneeberger, K, Wiegerinck, CL, et al. Adult stem cells in the small intestine are intrinsically programmed with their location-specific function. Stem Cells. 2014;32:1083–91.Google Scholar
Sidhu, R, Sanders, DS, Morris, AJ, et al. Guidelines on small bowel enteroscopy and capsule endoscopy in adults. Gut. 2008;57:125–36.Google Scholar
Kroner, PT, Brahmbhatt, BS, Bartel, MJ, et al. Yield of double-balloon enteroscopy in the diagnosis and treatment of small bowel strictures. Dig Liver Dis. 2016;48:446–8.CrossRefGoogle ScholarPubMed
McHugh, JB, Appelman, HD, McKenna, BJ. The diagnostic value of endoscopic terminal ileum biopsies. Am J Gastroenterol. 2007;102:1084–9.CrossRefGoogle ScholarPubMed
Zwas, FR, Bonheim, NA, Berken, CA, et al. Diagnostic yield of routine ileoscopy. Am J Gastroenterol. 1995;90:1441–3.Google Scholar
Cherian, S, Singh, P. Is routine ileoscopy useful? An observational study of procedure times, diagnostic yield, and learning curve. Am J Gastroenterol. 2004;99:2324–9.CrossRefGoogle ScholarPubMed
Coremans, G, Rutgeerts, P, Geboes, K, et al. The value of ileoscopy with biopsy in the diagnosis of intestinal Crohn’s disease. Gastrointest Endosc. 1984;30:167–72.Google Scholar
Bentsen, BS, Moum, B, Ekbom, A. Incidence of inflammatory bowel disease in children in Southeastern Norway. A prospective population-based study 1990–94.Scand J Gastroenterol. 2002;37:540–5.CrossRefGoogle ScholarPubMed
Schumacher, G, Kollberg, B, Sandstedt, B. A prospective study of first attacks of inflammatory bowel disease and infectious colitis. Histologic course during the 1st year after presentation. Scand J Gastroenterol. 1994;29:318–32.Google Scholar
Geboes, K, Ectors, N, D’Haens, G, et al. Is ileoscopy with biopsy worthwhile in patients presenting with symptoms of IBD. Am J Gastroenterol. 1998;93:201–6.Google Scholar
Das, P, Gahlot, GP, Mehta, R, et al. Interpretation of ileal biopsies. Indian J Pathol Microbiol. 2015;58:146–53.Google Scholar
Geboes, K. The strategy for biopsies of the terminal ileum should be evidence based. Am J Gastroenterol. 2007;102:1090–2.Google Scholar
Rostami, K, Aldulaimi, D, Holmes, G, et al. Microscopic enteritis: Bucharest consensus. World J Gastroenterol. 2015;21:2593–604.CrossRefGoogle ScholarPubMed
Webb, RA, Hoque, T, Dimas, S. Expulsion of the gastrointestinal cestode, Hymenolepisdiminuta by tolerant rats: evidence of mediation by a Th2 type immune enhanced goblet cell hyperplasia, increased mucin production and secretion. Parasite Immunol. 2007;9:11–21.Google Scholar
Cuvelier, C, Demetter, P, Mielants, H, et al. Interpretation of ileal biopsies: morphological features in normal and diseased mucosa. Histopathology. 2001;38:1–12.Google Scholar
Cuvelier, C, Barbatis, C, Mielants, H, et al. Histopathology of intestinal inflammation related to reactive arthritis. Gut. 1987;2:394–401.Google Scholar
Wada, F, Murase, K, Yoshio, Y, et al. Chronic nonspecific jejunitis: a case report. Acta Medica Nagasaki. 2000;45:53–6.Google Scholar
Bresee, JS, Marcus, R, Venezia, RA, et al. The etiology of severe acute gastroenteritis among adults visiting emergency departments in the United States. J Infect Dis. 2012;205:1374–81.CrossRefGoogle ScholarPubMed
Girard, MP, Steel, D, Chaignat, CL, et al. A review of vaccine research and development: human enteric infections. Vaccine. 2006;24:2732–50.Google Scholar
Petrogiannopoulos, CL, Kalogeropoulos, SG, Dandakis, DC, et al. Cytomegalovirus enteritis in an immunocompetent host. Chemotherapy. 2004;50:276–8.CrossRefGoogle Scholar
Lamps, LW. Infective disorders of the gastrointestinal tract. Histopathology. 2007;50:55–63.Google Scholar
Vantrappen, G, Ponette, E, Geboes, K, et al. Yersinia enteritis and enterocolitis: gastroenterological aspects. Gastroenterology. 1977;72:220–7.CrossRefGoogle ScholarPubMed
Naktin, J, Beavis, KG. Yersinia enterocolitica and Yersinia pseudotuberculosis. Clin Lab Med. 1999;19:523–36.Google Scholar
Dilauro, S, Crum-Cianflone, NF. Ileitis: when it is not Crohn’s disease. Curr Gastroenterol Rep. 2010;12:249–58.Google Scholar
O’Brien, BH, McClymont, K, Brown, I. Collagenous ileitis: a study of 13 cases. Am J Surg Pathol. 2011;35:1151–7.Google Scholar
Marteau, P, Lavergne-Slove, A, Lemann, M, et al. Primary ileal villous atrophy is often associated with microscopic colitis. Gut. 1997;41:561–4.CrossRefGoogle ScholarPubMed
Kaijser, R. Zur Kenntnis der allergischen Affektionen des Verdauugskanals vom Standpunkt des Chirurgen aus. Arch Klin Chir. 1937;188:36–64.Google Scholar
Baig, M, Qadir, A, Rasheed, J. A review of eosinophilic gastroenteritis. J Natl Med Assoc. 2006;98:1616–19.Google ScholarPubMed
Ingle, SB, Hinge, CR. Eosinophilic gastroenteritis: an unusual type of gastroenteritis. World J Gastroenterol. 2013;19:5061–6.Google Scholar
Théophile, H, David, XR, Miremont-Salamé, G, et al. Five cases of sprue-like enteropathy in patients treated with olmesartan. Dig Liver Dis. 2014;46:465–9.Google Scholar
Maes, BD, Dalle, I, Geboes, K, et al. Erosive enterocolitis in mycophenolate mofetil-treated renal transplant recipients with persistent afebrile diarrhea. Transplantation. 2003;15:665–72.Google Scholar
Carvalho, R, Almeida, N, Portela, F, et al. Terminal ileitis in a renal transplanted patient: could it be infectious ileitis, Crohn’s disease, or pharmacological toxicity? Inflamm Bowel Dis. 2011;17:E52–3.Google Scholar
Klimach, OE, Ormerod, LP. Gastrointestinal tuberculosis: a retrospective review of 109 cases in a district general hospital. Q J Med. 1985;56:569–78.Google Scholar
Pulimood, AB, Ramakrishna, BS, Kurion, G, et al. Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn’s disease from tuberculosis. Gut. 1999;45:537–41.Google Scholar
Almadi, MJ, Ghosh, S, Aljebreen, AM. Differentiating intestinal tuberculosis from Crohn’s disease: a diagnostic challenge. Am J Gastroenterol. 2009;104:1003–12.CrossRefGoogle ScholarPubMed
Geboes, K. Inflammatory disorders of the small intestine. In Shepherd, N, et al. (eds), Morson and Dawson’s Gastrointestinal Pathology, 5th ed. Chichester: Wiley-Blackwell, 2013; 315–72.Google Scholar
Langner, C, Magro, F, Driessen, A, et al. The histopathological approach to inflammatory bowel disease: a practice guide. Virchows Arch. 2014;464:511–27.Google Scholar
Magro, F, Langner, C, Driessen, A, et al. European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis. 2013;7:827–51.Google Scholar
Haskell, H, Andrews, CW, Reddy, SI, et al., Pathologic features and clinical significance of ‘backwash’ ileitis in ulcerative colitis. Am J Surg Pathol. 2005;29:1472–81.Google Scholar
Yamamoto, T, Maruyama, Y, Umegae, S, et al. Mucosal inflammation in the terminal ileum of ulcerative colitis patients: endoscopic findings and cytokine profiles. Dig Liver Dis. 2008;40:253–9.Google Scholar
Laghi, A, Borrelli, O, Paolantonio, P, et al. Contrast enhanced magnetic resonance imaging of the terminal ileum in children with Crohn’s disease. Gut. 2003;52:393–7.CrossRefGoogle ScholarPubMed
Goldstein, N, Dulai, M. Contemporary morphologic definition of backwash ileitis in ulcerative colitis and features that distinguish it from Crohn disease. Am J Clin Pathol. 2006;126:365–76.Google Scholar
Tong, YL, Chen, Y, Zhu, SY. Ileocecal endometriosis and a diagnostic dilemma: a case report and literature review. World J Gastroenterol. 2013;19:3707–10.CrossRefGoogle Scholar
Craninx, M, D’Haens, G, Cokelaere, K, et al. Crohn’s disease and intestinal endometriosis: an intriguing co-existence. Eur J Gastroenterol Hepatol. 2000;12:217–21.CrossRefGoogle ScholarPubMed
Mickys, U, Barakauskiene, A, De Wolf-Peeters, C, et al. Aggressive systemic mastocytosis complicated by protein-losing enteropathy. Dig Liver Dis. 2007;39:693–7.CrossRefGoogle ScholarPubMed
Chang, HS, Lee, D, Kim, JC, et al. Isolated terminal ileal ulcerations in asymptomatic individuals: natural course and clinical significance. Gastrointest Endosc. 2010;72:1226–32.Google Scholar
Goldstein, NS. Isolated ileal erosions in patients with mildly altered bowel habits. A follow-up study of 28 patients. Am J Clin Pathol. 2006;125:838–46.Google Scholar
Lengeling, RW, Mitros, FA, Brennan, JA, et al. Ulcerative ileitis encountered at ileo-colonoscopy: likely role of nonsteroidal agents. Clin Gastroenterol Hepatol. 2003;1:160–9.Google Scholar
O’Donnell, S, Crotty, PL, O’Sullivan, M, et al. Isolated active ileitis: is it a mild subtype of Crohn’s disease? Inflamm Bowel Dis. 2013;19:1815–22.Google Scholar
Courville, EL, Siegel, CA, Vay, T, et al. Isolated asymptomatic ileitis does not progress to overt Crohn disease on long term follow-up despite features of chronicity in ileal biopsies. Am J Surg Pathol. 2009;33:1341–7.Google Scholar
Fortun, PJ, Hawkey, CJ. Nonsteroidal anti-inflammatory drugs and the small intestine. Curr Opin Gastroenterol. 2005;21:169–75.Google Scholar
Fukumoto, A, Tanaka, S, Yamamoto, H, et al. Diagnosis and treatment of small-bowel stricture by double balloon endoscopy. Gastrointest Endosc. 2007;66:S108–12.CrossRefGoogle ScholarPubMed
Nakano, M, Oka, S, Tanaka, S, et al. Clinical usefulness of classification by transabdominal ultrasonography for detection of small-bowel stricture. Scand J Gastroenterol. 2013;48:1041–7.CrossRefGoogle ScholarPubMed
Almeida, N, Figueiredo, P, Lopes, S, et al. Double-balloon enteroscopy and small bowel tumours: a South-European single-center experience. Dig Dis Sci. 2009;54:1520–4.Google Scholar
Lang, J, Price, AB, Levi, AJ, et al. Diaphragm disease: pathology of disease of the small intestine induced by non-steroidal anti-inflammatory drugs. J Clin Pathol. 1988;41:516–26.Google Scholar
Jaqtap, SV, Nikumbh, DB, Kshirsagar, AY, et al. Unusual presentation of eosinophilic enteritis as multiple strictures of small intestine. Clin Pract. 2012;2:55–7.Google Scholar
Setaffy, L, Osuna, MJ, Plieschnegger, W, et al. Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) and neuromuscular and vascular hamartoma (NMVH): two sides of the same coin? Endoscopy. 2015;47:345–8.Google Scholar
Lee, HY, Howarth, G, Willert, R. A 75-year old woman with multifocal jejunal strictures. Gut. 2014;63:1979.CrossRefGoogle Scholar
Svrcek, M, Piton, G, Cosnes, J, et al. Small bowel adenocarcinomas complicating Crohn’s disease are associated with dysplasia: a pathological and molecular study. Inflamm Bowel Dis. 2014;20:1584–92.CrossRefGoogle ScholarPubMed
Geboes, K, De Wolf-Peeters, C. Neoplasms of the small intestine. In Scheppach, W, Bresalier, RS, Tytgat, G (eds), Gastrointestinal and Liver Tumors. Berlin: Springer-Verlag, 2004; 83–95.CrossRefGoogle Scholar
Ganly, I, Shouler, PJ. Focal lymphoid hyperplasia of the terminal ileum mimicking Crohn’s disease. Br J Clin Pract. 1996;50:348–9.Google Scholar
Molas, G, Potet, F, Nogiq, P . Focal lymphoid hyperplasia (pseudolymphoma) of the terminal ileum in adults. Gastroenterol Clin Biol. 1985;9:630–3.Google Scholar
Aqil, B, Xie, W, Szigeti, R. Lambda immunoglobulin light chain restricted B cells in the ascitic fluid in association with terminal ileal florid follicular Hyperplasia. Ann Clin Lab Sci. 2016;46:87–9.Google Scholar
Mojtahed, A, Pai, RK, Anderson, MW, et al. Reactive lymphoid hyperplasia of the terminal ileum: a benign (lymphoma-like) condition that may harbor aberrant immunohistochemical patterns or clonal immunoglobulin heavy chain gene rearrangements. Appl Immunohistochem Mol Morphol. 2014;22:585–92.CrossRefGoogle ScholarPubMed

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