Backwash Is Hogwash: The Clinical Significance of Ileitis in Ulcerative Colitis

  title={Backwash Is Hogwash: The Clinical Significance of Ileitis in Ulcerative Colitis},
  author={Deepa T. Patil and Robert D Odze},
  journal={The American Journal of Gastroenterology},
INTRODUCTION Up to 35% of patients with ulcerative colitis (UC) develop infl ammation in the terminal ileum, which historically, has been attributed to backwash of colonic contents into the terminal ileum, a condition termed “backwash ileitis” (BWI) ( 1–5 ). Th e hypothetical mechanism for this phenomenon is that when infl ammation of the proximal cecum/ileocecal mucosa is severe enough, it may cause malfunction of the ileocecal junction (ICJ) and retrograde fl ow of colonic contents into the… 
Microscopic / "Backwash" Ileitis and its Association with Colonic Disease in New Onset Pediatric Ulcerative Colitis.
Patients with new onset ulcerative colitis may have microscopic ileal inflammation at time of diagnosis, even if the terminal ileum appears macroscopically normal, and children with microscopic ilesitis in the context of UC do not need to be reclassified as "indeterminate colitis" or Crohn's disease.
Discrete terminal ileal ulcers in patients diagnosed with ulcerative colitis: clinical significance and natural course
Discrete TI ulcers are more common in patients with UC, compared with the healthy cohort, and no significant clinical impact on disease extension and severity is found.
A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in MR Enterography.
Two practical indices introduced in this study showed high specificity to distinguish BWI from CTI, including ileocecal valve patency indices-C and ICPI-T, which can accurately differentiate BWIFrom CTI.
Prognostic Value of Terminal Ileal Inflammation in Patients with Ulcerative Colitis
For patients with UC in clinical remission, neither terminal ileal lesions nor AOI had significant clinical or predictive value for future relapse.
Clinicopathologic Features and Diagnostic Implications of Pyloric Gland Metaplasia in Intestinal Specimens.
In conclusion, intestinal PGM warrants a high suspicion for IBD and specifically CD, however, it should be interpreted with caution, especially in older patients or those with a history of prior intestinal surgery and in colorectal biopsies or specimens lacking severely active inflammation.
Increase in chromogranin A- and serotonin-positive cells in pouch mucosa of patients with ulcerative colitis undergoing proctocolectomy.
  • P. Giuffrida, A. Vanoli, A. Di Sabatino
  • Medicine, Biology
    Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
  • 2018
Biopsy diagnosis of colitis: an algorithmic approach
This review will focus on a pattern-based algorithmic approach to evaluating biopsies of patients who present to physicians with signs and symptoms of colitis, to distinguish variations in normal mucosa and biopsy procedure-related artifacts from true inflammatory conditions.
Narrative review of colorectal cancer risk in patients with inflammatory bowel disease
Endoscopic surveillance programs have been implemented and are recommended depending on the risk factors of each patient, it is important to detect early precancerous lesions to perform timely treatment and prevent the development of CRC.
Ulcerative Colitis: Making the Diagnosis.


Pathologic Features and Clinical Significance of “Backwash” Ileitis in Ulcerative Colitis
Ileal changes in UC 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, and some cases are consistent with a backwash etiology.
Contemporary morphologic definition of backwash ileitis in ulcerative colitis and features that distinguish it from Crohn disease.
Terminal ileum (TI) sections from 250 ulcerative colitis (UC) total colectomy specimens resected during 3 periods and endoscopic TI biopsy specimens from 100 contemporary chronic UC and 100 Crohn disease patients were reviewed, finding the activity level of BWI correlated with level of cecal UC.
Ileitis in Ulcerative Colitis: Is It a Backwash?
Ileitis in ulcerative colitis is not rare and does influence the prognosis, and the term “backwash” is a misnomer.
Backwash Ileitis and the Risk of Colon Neoplasia in Ulcerative Colitis Patients Undergoing Restorative Proctocolectomy
The presence of BWI with extensive colitis was associated with the risk of identifying colon neoplasia but not cancer alone in the proctocolectomy specimen, and the presence of PSC was the only factor independently associated with an increased risk.
Backwash ileitis does not affect pouch outcome in patients with ulcerative colitis with restorative proctocolectomy.
  • A. Arrossi, Y. Kariv, J. Goldblum
  • Medicine
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
  • 2011
Diffuse Duodenitis Associated With Ulcerative Colitis
Patients with pancolitis and DD do not necessarily have CD, but rather may have UC and, most importantly, that successful ERPT procedures may be performed in these patients.
Mucosal inflammation in the terminal ileum of ulcerative colitis patients: endoscopic findings and cytokine profiles.
Backwash ileitis is strongly associated with colorectal carcinoma in ulcerative colitis.
There is a strong association of backwash ileitis with CRC in patients with ulcerative colitis who undergo proctocolectomy, and primary sclerosing cholangitis was strongly associated with backwash  ileitis.
The original description1in 1932 of a granulomatous, ulcerating and stenosing inflammation of the small intestine, denominated regional or terminal ileitis, covered fourteen cases of a uniform
Prospective Evaluation of Terminal Ileitis in a Surveillance Population of Patients with Ulcerative Colitis
Ileitis in Patients with UC may represent a primary extracolonic manifestation of UC in patients with inactive or mild disease and is not due to backwash.