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

@article{Patil2017BackwashIH,
  title={Backwash Is Hogwash: The Clinical Significance of Ileitis in Ulcerative Colitis},
  author={Deepa T. Patil and R. Odze},
  journal={The American Journal of Gastroenterology},
  year={2017},
  volume={112},
  pages={1211-1214}
}
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… Expand
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Microscopic / "Backwash" Ileitis and its Association with Colonic Disease in New Onset Pediatric Ulcerative Colitis.
TLDR
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. Expand
Discrete terminal ileal ulcers in patients diagnosed with ulcerative colitis: clinical significance and natural course
TLDR
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. Expand
Clinicopathologic Features and Diagnostic Implications of Pyloric Gland Metaplasia in Intestinal Specimens.
TLDR
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. Expand
Increase in chromogranin A- and serotonin-positive cells in pouch mucosa of patients with ulcerative colitis undergoing proctocolectomy.
  • P. Giuffrida, A. Vanoli, +15 authors A. Di Sabatino
  • Medicine
  • Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
  • 2018
BACKGROUND Inflammatory bowel disease (IBD) is associated with neuroendocrine cell hyperplasia. AIMS We investigated neuroendocrine cells in J-pouches of patients with ulcerative colitis undergoing… Expand
Biopsy diagnosis of colitis: an algorithmic approach
TLDR
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. Expand
Daily Dilemmas in Pediatric Gastrointestinal Pathology.
TLDR
3 diagnostic challenges that are often encountered in daily practice are outlined; these include eosinophilic diseases, duodenal intraepithelial lymphocytosis with preserved villous architecture, and terminal ileal inflammation in the setting of idiopathic inflammatory bowel disease. Expand
Ulcerative Colitis: Making the Diagnosis.
TLDR
Although laboratory and radiographic findings can aid in the diagnosis of ulcerative colitis, endoscopy remains the gold standard for diagnosis. Expand
Microscopic/"Backwash" Ileitis and Its Association With Colonic Disease in New Onset Pediatric Ulcerative Colitis.
TLDR
Patients with new onset UC 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 disease. Expand

References

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Pathologic Features and Clinical Significance of “Backwash” Ileitis in Ulcerative Colitis
TLDR
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. Expand
Contemporary morphologic definition of backwash ileitis in ulcerative colitis and features that distinguish it from Crohn disease.
TLDR
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. Expand
Ileitis in Ulcerative Colitis: Is It a Backwash?
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Ileitis in ulcerative colitis is not rare and does influence the prognosis, and the term “backwash” is a misnomer. Expand
Backwash Ileitis and the Risk of Colon Neoplasia in Ulcerative Colitis Patients Undergoing Restorative Proctocolectomy
TLDR
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. Expand
Backwash ileitis does not affect pouch outcome in patients with ulcerative colitis with restorative proctocolectomy.
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TLDR
Ileal inflammation is not a contraindication for restorative proctocolectomy with ileal pouch construction in patients with UC or idiopathic inflammatory bowel disease of indeterminate type and pouch outcomes are not affected. Expand
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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. Expand
Mucosal inflammation in the terminal ileum of ulcerative colitis patients: endoscopic findings and cytokine profiles.
TLDR
Elevated ileal cytokines might reflect a reaction to regurgitation of colonic content into the ileum, but in patients without backwash ileitis, alternative factors are expected to contribute to the aetiology of ILEal inflammation. Expand
Backwash ileitis is strongly associated with colorectal carcinoma in ulcerative colitis.
TLDR
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. Expand
A COMBINED FORM OF ILEITIS AND COLITIS
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… Expand
Prospective Evaluation of Terminal Ileitis in a Surveillance Population of Patients with Ulcerative Colitis
TLDR
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. Expand
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