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Ulcerative jejunoileitis and enteropathy-associated T-cell lymphoma
Christoph Elsing1, Jörg Placke, Wilhelm Gross-Weege
1Department of Gastroenterology and Surgery, St Elisabeth Hospital, Dorsten, Germany. c.elsing@krankenhaus-dorsten.de
European Journal of Gastroenterology & Hepatology
|November 18, 2005
Summary
Refractory coeliac disease can lead to rare ulcerative jejunoileitis and T-cell lymphoma. This case highlights two distinct mechanisms of small bowel ulceration, requiring tailored treatments.
Area of Science:
- Gastroenterology and Oncology
- Small Intestine Disorders
- Autoimmune Enteropathies
Background:
- Refractory coeliac disease (RCD) is associated with rare, severe small bowel complications.
- Ulcerative jejunoileitis and enteropathy-associated T-cell lymphoma (EATL) are recognized but infrequent sequelae.
- The etiology of repetitive ulcerations in unclassified enteropathies remains incompletely understood.
Observation:
- A female patient with unclassified enteropathy presented with recurrent jejunoileal ulcerations.
- Multiple small bowel resections were required due to the severity and frequency of ulcerations.
- Ulcerations were attributed to either cytotoxic T-cell activity (associated with T-cell lymphoma) or gastric metaplasia with acid production.
Findings:
- The patient developed enteropathy-associated T-cell lymphoma, with malignant cells identified in ulcer bases.
- An alternative mechanism involved acid-producing cells in gastric metaplasia contributing to ulcer formation.
- Two distinct pathophysiological pathways for repetitive small bowel ulceration were identified in this case.
Implications:
- Understanding these distinct mechanisms is crucial for selecting appropriate therapeutic strategies.
- Treatment approaches may differ significantly based on whether ulceration is T-cell driven or acid-mediated.
- Current management includes proton pump inhibitors, steroids, and parenteral nutrition, pending definitive etiological treatment.