Chronic non-specific ulcerative duodenojejunoileitis: report of four cases.

Abstract

SUMMARY Four patients with chronic non-specific ulcerative duodenojejunoileitis (CNSUDJI) are reported. The clinical picture included abdominal pain, fever, and a malabsorption syndrome. Main radiological findings were diffuse narrowing of the jejunal loops with total effacement of the mucosal folds. Multiple peroral biopsies of the small intestine showed various degrees of mucosal abnormalities from total villous atrophy to normal villi, but ulcerations were diagnosed only by operative full thickness biopsies or resection of the small bowel. The ulcerative process was associated with well-documented coeliac disease in two patients: in one of them it occurred as a fatal complication involving also the colon, three years after the start of a gluten free diet, while the disease was in full clinical and histological remission. In the other case, coeliac disease was revealed by obstructive symptoms due to stenosing ulcerations; five months after surgical resection of the stenosis, institution of a gluten free diet induced a dramatic improvement. In the two other patients ulcerations were not associated with coeliac disease: one of them had a patchy villous atrophy and resisted a gluten free diet and total parenteral nutrition; she was improved by and dependent upon steroids but finally died. The last patient had normal villous height; ulcerations were located exclusively along the mesenteric border of the small bowel; he had a low-grade protracted evolution resisting any form of therapy and developed a peripheral neuropathy of unknown aetiology. On the basis of our cases and of a review of the literature the discussion focuses on the difficulty in diagnosing CNSUDJI, its relationship with coeliac disease, and its management and prognosis.

Non-specific multiple ulcers of the small intestine unrelated to non-steroidal anti-inflammatory drugs

“…10 Robertson et al subsequently reported seven patients with similar clinicopathological features. 11 Modigliani and colleagues and Robertson and colleagues 11 suggested that the small intestinal ulcers might be related to coeliac disease, because their patients had been diagnosed with this disease or because the ulcers were accompanied by various degrees of mucosal atrophy.…”

“…8 9 In contrast, cases of unexplained chronic, non-specific small intestinal ulcers have been reported in the literature. Modigliani and colleagues 10 and Robertson and colleagues 11 described small intestinal ulcers that were accompanied by villous atrophy, and they referred to the condition as chronic non-specific ulcerative duodenojejunoileitis. More recently, chronic and recurrent small intestinal pathology characterised by non-specific stenosis and superficial ulcers has become accepted as a distinctive entity.…”

Idiopathic Chronic Ulcerative Enteritis – The Role of Radical Surgical Resection

“…A review of the literature regarding all cases of nonspecific or ICUE (n = 170) has been discussed by Thomas and Williamson [5]. However, since the first description by Nyman in 1949, numerous descriptive terms have been used [6]including ulcerative jejunitis [7], chronic ulcerative jejunoileitis [8], nongranulomatous ulcerative jejunoileitis [9]and chronic nonspecific ulcerative duodenojejunoileitis [10]. Furthermore, there have been descriptions of patients with malabsorption in association with diffuse or patchy jejunal villous atrophy who do not respond to the first attempts at conservative treatment such as a gluten free diet or adrenocortical steroids.…”

Akutes Abdomen bei einheimischer Sprue — eine seltene Komplikation

“…Teil der Patienten verstarb zurn Teil bereits an peri-/postoperativen Komplikationen, zum Teil im Verlaufvon wenigenJ.ahren; die wenigen F~Ue mit l~ingerer Uberlebenszeit waren offensichflich kurativ ope¡ worden [10,11,14].…”