Analysis of the characteristics of terminal ileal ulcers: prognosis and clinical significance

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.


Introduction
The terminal ileum refers to ileum approximately 30 cm in length from the ileocecal valve to anal side of the ileum. This location is a predilection site for small bowel disease. The long-term clinical findings indicate that the onset of this site is occult and the patient's clinical symptoms and signs are often not obvious on the early stage, which makes early diagnosis more difficult. Crohn's disease [1], intestinal tuberculosis [2], and small intestinal lymphoma [3] all occur in terminal ileum, and early diagnosis is difficult. The characteristics of these diseases can be manifested as congestion, edema, ulcers and even bleeding in terminal ileum. In recent years, with the continuous improvement of medical technology, colonoscopy has been widely popularized. Combining colonoscopy diagnosis technology with histopathological results greatly improves the diagnostic accuracy rate of terminal ileum lesions [4]. In addition to these digestive diseases, the detection rate of simple ileal ulcer lesions is also increasing while the disease itself is not specific.
In our study, we aimed to collect patients diagnosed as terminal ileal ulcers by colonoscopy and to evaluate the diagnostic value and diagnostic accuracy of electronic colonoscopy and histopathological examination for terminal ileal ulcers. In addition, through analyzing characteristics of various types of terminal ileal ulcers, we try to contribute to the understanding of the diagnosis and differential diagnosis of terminal ileal ulcers.
Methods And Materials 1.

Patients and diagnostic criteria
We screened about 40,000 individuals who underwent colonoscopy in our hospital from

Data extraction
We extracted data of gender, age, clinical symptoms, number of terminal ileal ulcers, pathological outcome, treatment programs. The symptoms of 42 individuals were mainly abdominal pain, diarrhea, constipation, dyspepsia, and physical examination.

Statistical analysis
Continuous variables were expressed as a mean ± standard deviation. Student's t-test was used to compare the difference of age between different subgroups. Chi-square test is used to compare categorical variables, such as gender, ulcer. Logistic regression is used to compare the relationship between drug selection and multiple variables. The statistical significance was defined as P≤0.05. We used SPSS 21.0 (IBM, Chicago, IL, USA) to perform the statistical analysis.

Results
The baseline characteristics were shown in    [6]. While some scholars believe that it is caused by Campylobacter infection [6].
Small ulcerations in the terminal ileum may be one of the earliest manifestations of serious diseases, such as Crohn's disease. Some studies reported that patients with aphthous-type Crohn's disease may later develop typical Crohn's disease [7,8]. There was also researcher who hold the opposite view. Courville EL et al has reported that Crohn's disease is unlikely to develop in asymptomatic individuals with isolated ileitis[9]. In our study, we also did not find the development of Crohn's disease. Moreover, long-term follow-up studies and prospective multicenter study are needed to assess this hypothesis accurately, because this progression may take place over after a period of time.
There were a few limitations in our study. Firstly, limited number of individuals enrolled.
In Third, this study did not involve the study of etiology, pathogenesis and risk factors.
Moreover, the results of this study also did not represent other countries, especially the West. Finally, although we have followed the individuals for a certain period of time, we still don't know the longer-time evolution of the lesions. Therefore, we can't make any definite recommendations on how to manage these lesions.

Conclusions
In Liping Yang wrote the paper; Chunxiao Chen revised the paper.

Supplementary Files
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Institutional Review Board Approval.pdf