"Backwash ileitis" with pseudopolyposis

Gardiner, G.A.

doi:10.2214/ajr.129.3.506

Cited by 15 publications

(6 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5,7,10,24,34 Indeed, some cases reported strictures, pseudopolyps, and extensive ulceration in ''backwash'' ileitis, none of which were present in our current study. 5,10,24 However, none of those earlier reports outlined pathologic criteria for ''backwash'' ileitis or used methods, or clinical follow-up, to confirm the absence of CD. Traditionally, ileitis in UC has been thought to develop as a result of reflux of colonic contents into the ileum due to an incompetent, or poorly functioning, and inflamed ileocecal valve.…”

Section: Discussioncontrasting

confidence: 40%

“…Interestingly, some reports have indeed documented the presence of ileitis in UC patients without contiguous ileocecal involvement. 10,11,23,35 For instance, in a study by Lumb and Protheroe in 1958, some cases of so-called ''backwash'' ileitis developed in patients without ileocecal valve, or cecal, involvement. 23 In our current study, although most patients (94%) with ileitis had pancolitis and had severe disease with involvement of the cecum (65%), some of our data do not support the backwash theory as the only mechanism of ileal inflammation in UC.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, since White first described ileal involvement in 5 of 11 UC cases, in a detailed descriptive pathologic study from Guy Hospital in London in 1888, 39 there has been only scattered individual case reports, or small descriptive series, that have described the morphologic features of the ileum in UC. [5][6][7]9,10,12,[24][25][26]34 Indeed, in many of these archival reports, it is unclear if any of the patients either had, or developed, CD. Nevertheless, the term ''backwash'' ileitis has become engrained in the literature despite the lack of proof for backwash as the principal method of pathogenesis of this condition.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Pathologic Features and Clinical Significance of ???Backwash??? Ileitis in Ulcerative Colitis

Haskell

Andrews²,

Reddy³

et al. 2005

The American Journal of Surgical Pathology

193

View full text Add to dashboard Cite

Patients with ulcerative colitis (UC) may develop inflammation in the distal ileum thought to be due to "backwash" of cecal contents ("backwash ileitis"). However, a systematic analysis of ileal changes in UC has never been performed, and the prevalence and criteria for "backwash" ileitis have not been defined. The aim of this study was to evaluate the prevalence and spectrum of inflammatory changes in the ileum in patients with UC and to correlate ileal changes with outcome after total proctocolectomy and ileal pouch-anal anastomosis. Routinely processed ileocolonic resection specimens from 200 consecutive patients with clinically and pathologically confirmed UC were evaluated for a wide variety of pathologic features in the ileum and colon. The ileal data were correlated with both the clinical features and the pathologic findings in the colon. Follow-up data were obtained to confirm absence of Crohn's disease and to evaluate outcome of ileo-anal pouches. Overall, 34 of 200 (17%) UC patients had inflammatory changes in the ileum (male/female ratio, 16/18; mean age, 42 years); 32 of 34 (94%) had pancolitis, which was significantly higher than the rate of pancolitis (39%) in patients without ileal disease (N = 166) (P < 0.001), but there were no other differences between patients with or without ileal pathology. In the colon, 22 of 34 (65%) patients had severe activity. Ileal changes included villous atrophy and crypt regeneration without increased inflammation (N = 3), increased neutrophilic and mononuclear inflammation in the lamina propria (N = 6), patchy cryptitis and crypt abscesses (N = 21) and focal superficial surface erosions (N = 4), some with pyloric metaplasia (N = 2 of 4). In general, the severity of ileal changes paralleled the severity of colonic activity. However, 2 of 4 (50%) patients with superficial erosions in the ileum had subtotal or left-sided colitis only, and had only mild colonic activity. Other cases showed only mild to moderate colonic activity and patchy or discontinuous involvement of the distal ileum. Upon follow-up of patients with erosions (mean, 48.5 months; range, 26-102 months), none developed manifestations of Crohn's disease anywhere in the gastrointestinal tract. The presence of inflammatory changes in the ileum had no effect on the prevalence of pouch complications or on the occurrence of dysplasia or cancer. Ileal changes in UC are not uncommon (prevalence, 17%), are generally mild in nature (villous atrophy, increased inflammation, scattered crypt abscesses), and are not associated with an increased rate of ileo-anal pouch complications, dysplasia, or carcinoma. In some cases, our findings are consistent with a backwash etiology. However, rarely, ileal erosions may occur in patients without cecal involvement, which may indicate that other pathogenetic mechanisms should be considered in the etiology of ileitis in UC patients.

show abstract

Section: Discussioncontrasting

confidence: 40%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Pathologic Features and Clinical Significance of ???Backwash??? Ileitis in Ulcerative Colitis

Haskell

Andrews²,

Reddy³

et al. 2005

The American Journal of Surgical Pathology

193

View full text Add to dashboard Cite

show abstract

“…However, as CD can involve the entire gastrointestinal tract, the PPs can be present throughout but have been detected less often in extra-colonic regions. There is an exception to this distribution pattern for UC patients with backwash ileitis, wherein PPs have also been found at the terminal ileum[18]. There are also reports of PPs located at the esophagus[19], stomach[20], and different parts of the small bowel[21], with ileum presentation predominating in the latter[22].…”

Section: Location and Distribution Of Ppsmentioning

confidence: 99%

Pseudopolyps in inflammatory bowel diseases: Have we learned enough?

Politis

Κατσάνος

Tsianos

et al. 2017

WJG

View full text Add to dashboard Cite

Pseudopolyps are a well described entity in the literature and even though the exact pathogenesis of their formation is not completely understood, they are considered non-neoplastic lesions originating from the mucosa after repeated periods of inflammation and ulceration associated with excessive healing processes. Their occurrence is less common in Crohn's disease than in ulcerative colitis, and their overall prevalence ranges from 4% to 74%; moreover, they are found more often in colon but have been detected in other parts of the gastrointestinal tract as well. When their size exceeds the arbitrary point of 1.5 cm, they are classified as giant pseudopolyps. Clinical evaluation should differentiate the pseudopolyps from other polypoid lesions, such as the dysplasia-associated mass or lesion, but this situation represents an ongoing clinical challenge. Pseudopolyps can provoke complications such as bleeding or obstruction, and their management includes medical therapy, endoscopy and surgery; however, no consensus exists about the optimal treatment approach. Patients with pseudopolyps are considered at intermediate risk for colorectal cancer and regular endoscopic monitoring is recommended. Through a review of the literature, we provide here a proposed classification of the characteristics of pseudopolyps.

show abstract

“…¾tiopathogenetisch wird initial eine Lymphfollikulitis diskutiert [10]. Bei einer Pancolitis ulcerosa findet man in 10 % zusätzlich eine Backwash-Ileitis, selten sogar mit großen Pseudopolypen [11]. Das endoskopische Ausmaß und die Aktivität der Colitis verändern sich über die Zeit [12,13].…”

Section: Allgemeine Hinweiseunclassified

Endoskopie bei CED

Petritsch

Tillinger²,

Vogelsang³

et al. 2006

Z Gastroenterol

View full text Add to dashboard Cite

Ileocolonoscopy including biopsies is the first line investigation in suspected inflammatory bowel disease (IBD). In up to 90 % of the cases ulcerative colitis and Crohn's disease are differentiated on endoscopic presentation. Standardised reporting of endoscopic results increases the validity and comparability of IBD findings. When there is a firm diagnosis of IBD, colonoscopy should only be performed for specific questions. An upper gastrointestinal endoscopy is only indicated in patients with upper gastrointestinal symptoms. Push and capsule endoscopy should also be limited to specific questions and situations. IBD with extended colitis is associated with an increased risk for colorectal cancer. Endoscopic surveillance with accurate biopsy sampling is a valuable tool for the prevention of colorectal cancer.

show abstract

"Backwash ileitis" with pseudopolyposis

Cited by 15 publications

References 2 publications

Pathologic Features and Clinical Significance of ???Backwash??? Ileitis in Ulcerative Colitis

Pathologic Features and Clinical Significance of ???Backwash??? Ileitis in Ulcerative Colitis

Pseudopolyps in inflammatory bowel diseases: Have we learned enough?

Endoskopie bei CED

Contact Info

Product

Resources

About