Pathologic Features and Clinical Significance of “Backwash” Ileitis in Ulcerative Colitis

  title={Pathologic Features and Clinical Significance of “Backwash” Ileitis in Ulcerative Colitis},
  author={Henry L. Haskell and Charles W. Andrews and Sarathchandra I. Reddy and Kleanthis G. Dendrinos and Francis A. Farraye and Arthur F. Stucchi and James M. Becker and Robert D Odze},
  journal={The American Journal of Surgical Pathology},
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… 
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.
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.
Mucosal inflammation in the terminal ileum of ulcerative colitis patients: endoscopic findings and cytokine profiles.
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
Pathologic Features of Ulcerative Colitis in Patients With Primary Sclerosing Cholangitis: A Case-control Study
UC patients with PSC show a propensity for more extensive, but less active, disease but are otherwise characterized by similar pathologic findings compared with UC patients without PSC.
Backwash Is Hogwash: The Clinical Significance of Ileitis in Ulcerative Colitis
Evidence is cited to propose that ileal infl ammation in UC may simply represent a primary manifestation of UC in that organ, for which the term “UC-associated ileitis” is proposed.
Ileal Perforation in a Patient with Ulcerative Colitis after Proctocolectomy
A 66-year-old male with UC who presented with ileal perforation eight days after proctocolectomy is reported, indicating that backwash ileitis or diffuse enteritis is the most probable diagnosis in this case.
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.
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.
Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis: relationship with colonic metaplasia.
Findings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA, which may contribute to the development of colonic metaplasia.


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.
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.
Is Ileoscopy With Biopsy Worthwhile in Patients Presenting With Symptoms of Inflammatory Bowel Disease?
Ileoscopy with biopsy is useful in carefully selected patients presenting with symptoms of inflammatory bowel disease, and main indications are diagnosis of isolated ileal disease in the presence of a normal colon and differential diagnosis in patients with pancolitis and predominantly left-sided colitis.
Pathology of indeterminate colitis.
  • R. Odze
  • Medicine
    Journal of clinical gastroenterology
  • 2004
The natural history of IC more closely resembles that of UC than CD, supporting the notion that most patients with IC probably have UC and can safely undergo an ileal pouch-anal anastomosis procedure and have a reasonably good chance of having a good outcome.
Comparative features and course of ulcerative and granulomatous colitis.
Patients with clinical and microscopical features considered typical of granulomatous colitis tended to require more ileostomy revisions, but the long-term course after total colectomy and ILEostomy was similar for both forms of colitis.
PSC-IBD: a unique form of inflammatory bowel disease associated with primary sclerosing cholangitis
Colorectal neoplasia develops in a substantial fraction and overall survival is worse and PSC-IBD may represent a distinct IBD phenotype.
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