Case series of Cryptogenic Multifocal Ulcerating Stenosing Enteritis (CMUSE).

Area of Science:

• Gastroenterology
• Inflammatory Bowel Disease Research
• Diagnostic Endoscopy

Background:

• Small bowel ulceration has a complex differential diagnosis including Crohn's disease (CD), NSAID enteritis, lymphoma, cytomegalovirus, and tuberculosis.
• Cryptogenic multifocal ulcerative stenosing enteritis (CMUSE) is a less recognized but important differential diagnosis for small bowel ulcerations.

Observation:

• Balloon-assisted enteroscopy identified endoscopic features of CMUSE in five patients.
• Patients presented with short, circular, ulcerative stenoses in the jejunum or ileum, ranging from 1 to 7 per patient.
• Histopathology revealed nonspecific granulocyte inflammation, lacking specific CD findings.

Findings:

• Ulcerative stenoses were frequently missed on pre-enteroscopy CT or MRI enteroclysis due to their short length.
• Treatments included endoscopic balloon dilation, corticosteroids, azathioprine, and anti-TNFα biologicals.
• Three patients required surgery due to persistent symptomatic stenosis or retained videocapsules.

Implications:

• CMUSE is a distinct, rare chronic inflammatory bowel disease that should be considered in patients with short, ulcerative small intestinal stenoses.
• Specific endoscopic characteristics and histopathological findings differentiate CMUSE from other conditions.
• Further research is needed to understand the pathophysiology and relationship of CMUSE to CD.