Background Although terminal ileal ulcers can be observed occasionally in colonoscopy examination, the prognosis, clinical significance and treatment guidelines are unclear. Methods All patients diagnosed with terminal ileal ulcers from March 2014 to March 2018 were enrolled. We extracted data of gender, age, clinical symptoms, number of terminal ileal ulcers, pathological outcome, treatment programs. Results Of 42 individuals, one patient diagnosed with tuberculosis and received anti-tuberculosis treatment. The other 41 individuals chose to follow up or 5-ASA plus probiotics treatment. Logistic regression analysis showed no significant difference in treatment selection and gender (P=0.848), age (P=0.481), ulcers (p=0.116), symptoms (P=0.326). All individuals had good prognosis. Conclusion Individuals with terminal ileal ulcers have a good prognosis regardless of follow-up or treatment.