Long-term follow-up of nonspecific small bowel ulcers with a benign course and no requirement for surgery: is this a distinct group?

Abstract

BackgroundNonspecific small bowel ulcers are rare and surgical intervention is often believed to be elective. Since the extensive investigation of the small bowel in the 1990s, there have been limited reports of these ulcers and the updates have been unsatisfactory. The aim of this study was to explore the clinical features and natural histories of nonspecific small bowel ulcers through prospective observational study.MethodsWe reviewed the medical records of all patients who had undergone ileocolonoscopy or enteroscopy between 2000 and 2005 in a tertiary referral hospital. Seven patients with small bowel ulcers of unknown cause were identified. These patients were prospectively followed in a prolonged observation until March 2010.ResultsAll seven patients (mean age: 54.7 years) presented with mild gastrointestinal symptoms, including chronic diarrhea and/or abdominal pain/discomfort, except for one who was asymptomatic when surveyed for colon polyps. Most patients were suspected of having functional bowel disorders for a long time (4.4 years) before small bowel ulcers were demonstrated on ileoscopy. The ulcers were characteristically multiple, superficial, and small (3-6 mm), locating at the terminal ileum and/or ileocecal valve. Various empirical treatments were applied, and most patients felt partly improved, even relieved. However the gastrointestinal symptoms did not always correlate with the presence of ulcers, and the ulcers tended to be either persistent (4 patients) or recurrent (1 patient). Ileocolonoscopy was repeated 4.1 times during follow-up, even after the lesions had healed. The characteristics of the ulcers, if still present during follow-up, were similar to their earlier characteristics. No patient experienced exacerbation or complications, such as intestinal obstruction, perforation, or bleeding. All patient survived and no surgical intervention was involved during the prolonged follow-up (7.0 years).ConclusionThe reported patients with nonspecific small bowel ulcers experienced benign courses, inconsistent with previous reports. Without extensive investigation, this disease can be confused with functional bowel disorders.

Symptomatic isolated terminal ileal ulcers: etiology and clinical significance

“…Most of these (88.9 %) responded to symptomatic management and 84 % had endoscopic resolution on follow-up, thus highlighting the fact that nonspecific terminal ileal ulcers have a benign clinical course and are not associated with any serious complications that may need surgical intervention. Similar findings were noted in a study from China 11 , where seven patients were followed up for 7 years. Colonic lavage using polyethylene glycol (PEG) or sodium phosphate before colonoscopy can also cause aphthous ulcers in the intestines 12 13 14 .…”

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“…Most of these (88.9 %) responded to symptomatic management and 84 % had endoscopic resolution on follow-up, thus highlighting the fact that nonspecific terminal ileal ulcers have a benign clinical course and are not associated ▶ with any serious complications that may need surgical intervention. Similar findings were noted in a study from China [11], where seven patients were followed up for 7 years. Colonic lavage using polyethylene glycol (PEG) or sodium phosphate before colonoscopy can also cause aphthous ulcers in the intestines [12 -14].…”

Frequency, natural course and clinical significance of symptomatic terminal ileitis

“…A recent study reviewed seven patients with non‐specific small bowel ulcers (superficial and small). All except one patient had mild GI symptoms and were treated as having functional GI disorders for a long time (4.4 years).…”