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Chapter 20 - Microscopic Colitis

Published online by Cambridge University Press:  06 June 2020

By
Maurice B. Loughrey
Edited by
Roger M. Feakins
Roger M. Feakins
Affiliation:
Royal Free London NHS Foundation Trust, London, UK
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Summary

The small intestine has three structural parts: duodenum, jejunum and ileum. The jejunum and ileum are about 2.5 m long and 3 m long respectively in adults and form the majority of the small intestine, which has a total mucosal surface area of approximately 30 square metres. The small intestine was long regarded as a place where little happens, essentially because visualisation was imprecise or inaccurate. With the development of flexible endoscopy, it was possible first to reach the ileum because of ileocolonoscopy, and later to reach the jejunum because of enteroscopy. As a result of these developments, biopsies from the ileum and jejunum are now part of routine histopathological practice. The pathology may include neoplastic and inflammatory diseases. This chapter on jejunitis and ileitis focuses mainly on the inflammatory conditions. These can be limited to the small intestine, jejunum, and/or terminal ileum, or may also involve the upper gastrointestinal tract and/or colon and rectum. The text includes a description of both acute, usually infectious, diseases, and chronic inflammatory diseases. There are many chronic diseases, affecting in particular the terminal ileum. Clinically, Crohn’s disease is often a consideration. Drug-induced lesions, infections, endometriosis, ulcerative colitis, lymphoma, and lymphoid hyperplasia can mimic Crohn’s disease of the terminal ileum. Biopsies can help to solve the differential diagnosis and orient the clinical team towards proper management of the patient.

Keywords

biopsiesnormal small intestinal mucosaPeyer’s patchjejunitisileitisacute enteritisisolated ileitischronic ileitislymphoid hyperplasiainfection
Type
Chapter
Information
Non-Neoplastic Pathology of the Gastrointestinal Tract
A Practical Guide to Biopsy Diagnosis
 , pp. 310 - 324
Publisher: Cambridge University Press
Print publication year: 2020

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