Incidental Finding of Terminal Ileum Inflammation on Screening Colonoscopy: Approach to Diagnosis and Workup
Résumé
Key Takeaways
Incidental terminal ileitis is identified in ~1.6% of screening colonoscopies.
Isolated terminal ileal inflammation without symptoms often resolves without treatment.
The presence of symptoms, not chronicity on biopsies, is the best predictor of isolated ileitis progressing to overt Crohn’s disease.
Use a fecal calprotectin cutoff of >200 µg/g to identify inflammation in isolated ileal Crohn’s disease.
Références
Colorectal Cancer Canada. Colorectal Cancer Screening [Internet]. Westmount QC; 2026 [cited 2026 Apr 29]. Available from: https://www.colorectalcancercanada.com/screening/colorectal-cancer-screening/
Ma C, Lumb R, Walker EV, Foshaug RR, Dang TT, Verma S, et al. Noninvasive fecal immunochemical testing and fecal calprotectin predict mucosal healing in inflammatory bowel disease: a prospective cohort study. Inflamm Bowel Dis. 2017;23(9):1643-1649. doi:10.1097/MIB.0000000000001173
Bojic D, Markovic S. Terminal ileitis is not always Crohn’s disease. Ann Gastroenterol. 2011;24(4):271-275.
Nandi N, Tai FWD, McAlindon M, Sidhu R. Idiopathic terminal ileitis: myth or true entity? Curr Opin Gastroenterol. 2024;40(3):217-224. doi:10.1097/MOG.0000000000001011
Agrawal M, Miranda MB, Walsh S, Narula N, Colombel JF, Ungaro RC. Prevalence and progression of incidental terminal ileitis on non-diagnostic colonoscopy: a systematic review and meta-analysis. J Crohns Colitis. 2021;15(9):1455-1463. doi:10.1093/ecco-jcc/jjab030
Bronze S, Shenoy S, Agrawal M, Polydorides AD, Colombel JF, Rodríguez-Lago I, et al. Prevalence and clinical features of incidental inflammatory bowel disease identified during screening and surveillance colonoscopy. Dig Dis Sci. 2026;71(2):578-583. doi:10.1007/s10620-025-09400-5
Chang HS, Lee D, Kim JC, Song HK, Lee HJ, Chung EJ, et al. Isolated terminal ileal ulcerations in asymptomatic individuals: natural course and clinical significance. Gastrointest Endosc. 2010;72(6):1226-1232. doi:10.1016/j.gie.2010.08.029
Kim JH, Lee JY, Park YE, Lee JH, Park J, Kim TO, et al. Clinical course of terminal ileal ulcers observed incidentally during colonoscopy. Dig Dis Sci. 2021;66(12):4423-4428. doi:10.1007/s10620-020-06781-7
Courville EL, Siegel CA, Vay T, Wilcox AR, Suriawinata AA, Srivastava A. 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(9):1341-1347. doi:10.1097/PAS.0b013e3181ad25b6
Smith RL, Taylor KM, Friedman AB, Majeed A, Perera N, Gibson PR. Nonspecific ileitis: impact of histopathology and gastrointestinal ultrasound in achieving the diagnosis of Crohn’s disease. JGH Open. 2022;6(6):388-394. doi:10.1002/jgh3.12740
Kim WJ, Lee CM, Jang JO, Kim SJ, Choi CW, Park SB. Clinical features and differential diagnosis in symptomatic localized terminal ileitis or ulcer. Medicine (Baltimore). 2025;104(19):e42432. doi:10.1097/MD.0000000000042432
Buisson A, Mak WY, Andersen MJ, Lei D, Pekow J, Cohen RD, et al. Fecal calprotectin is highly effective to detect endoscopic ulcerations in Crohn’s disease regardless of disease location. Inflamm Bowel Dis. 2021;27(7):1008-1016. doi:10.1093/ibd/izaa269
Elmasry S, Ha C. Evidence-based approach to the management of mild Crohn’s disease. Clin Gastroenterol Hepatol. 2024;22(3):480-483. doi:10.1016/j.cgh.2023.11.011
Panaccione R, Steinhart AH, Bressler B, Khanna R, Marshall JK, Targownik L, et al. Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Luminal Crohn’s Disease. J Can Assoc Gastroenterol. 2019;2(3):e1-e34. doi:10.1093/jcag/gwz019
Elmasry S, Ha C. Evidence-based approach to the management of mild Crohn’s disease. Clin Gastroenterol Hepatol. 2024;22(3):480-483. doi:10.1016/j.cgh.2023.11.011
Téléchargements
Publié
Comment citer
Numéro
Rubrique
Licence
© Canadian IBD Today 2026

Cette œuvre est sous licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.