P0541 Etiology and Differential Diagnosis of Terminal Ileum Lesions with Symptoms: A Retrospective Study of 224 Patients

Abstract Background The precise diagnosis and management of terminal ileum lesions with symptoms present substantial challenges. These lesions are frequently encountered during ileocolonoscopy and may be indicative of a broad spectrum of underlying pathologies. The aim of this study was to elucidate the etiology of terminal ileum lesions with symptoms and to differentiate among the diverse array of diseases associated with this condition. Methods This retrospective study included patients diagnosed with symptomatic terminal ileum lesions, who exhibited no colonic abnormalities on ileocolonoscopy, and presented with various symptoms at a tertiary referral center between January 2018 and October 2023. Demographic data, clinical manifestations, and endoscopic findings were systematically collected and analyzed. Results Of 224 patients with terminal ileum lesions on ileocolonoscopy, 110 presented with symptoms. Among these, 71 had specific etiologies identified at initial testing and 6-month follow-up: Crohn’s disease (CD) in 30 patients, Behçet’s disease (BD) in 20, infectious enteritis in 10, drug-induced ulcers in 5, intestinal tuberculosis (ITB) in 5, lymphoma in 1, and 40 had nonspecific ulcers. After one year of treatment, symptomatic and endoscopic resolution was achieved in 7/30 patients with CD and 10/20 patients with BD. Of the 40 with nonspecific ulcers and persistent symptoms, two were later diagnosed with CD. Conclusion In this study, more than half of patients with symptomatic terminal ileum lesions were diagnosed with an underlying disease, with CD and BD being the most prevalent. Integrating clinical characteristics, such as oral and genital ulcers, hemoglobin levels, and CRP, alongside endoscopic findings, can aid in the differential diagnosis of these lesions. Given that a definitive diagnosis was made in half of the symptomatic patients, accurate diagnosis and appropriate follow-up treatment are crucial. References: 1. 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. 2. Kim JH, Lee JY, Park YE, et al; Busan Ulsan Gyeongnam Intestinal Study Group Society (BIGS). Clinical course of terminal ileal ulcers observed incidentally during colonoscopy. Dig Dis Sci.2021;66:4423-8. 3. Sachdeva K, Agarwal S, Kumar P, et al. Revised algorithmic approach to differentiate between nonspecific and specific etiologies of chronic terminal ileitis. Am J Gastroenterol. 2023;118:2052-60. 4. Gomollon F, Dignass A, Annese V, et al; ECCO. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis. 2017;11:3-25. Conflict of interest: Dr. Kim, Woo Jin: No conflict of interest Park, Su Bum: No conflict of interest Choi, Cheol Woong: No conflict of interest Jang, Jinook: No conflict of interest Lee, Cheol Min: No conflict of interest