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Ulcerative Jejunitis in Celiac Disease: A 30-Year US Experience
Yevgen Chornenkyy1, Masa Peric1, David Marin Flores2
1Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Ulcerative enteritis (UE), a rare celiac disease complication, presents risks of obstruction and bleeding. Treatment outcomes for UE are variable, with a significant mortality rate, necessitating further research into effective management strategies.
Area of Science:
- Gastroenterology
- Immunology
- Oncology
Background:
- Ulcerative jejunitis (UJ) or ulcerative enteritis (UE) is a rare complication of celiac disease (CeD).
- Diagnostic and management guidelines for UE are lacking.
- Limited case reports of UE exist in the United States.
Purpose of the Study:
- To describe the clinical presentation, diagnosis, treatment, and outcomes of ulcerative enteritis in patients with celiac disease.
- To evaluate the efficacy of different treatment modalities for UE.
- To determine the appropriate terminology for this complication.
Main Methods:
- A case series was conducted at a large academic center in the United States.
- Data collected included clinical presentation, diagnostic findings, treatment interventions, and disease evolution.
- Eight cases of CeD with UE were identified and analyzed.
Main Results:
- Presentations included intestinal obstruction, GI hemorrhage, and malabsorption.
- Ulcers were found in the duodenum and exclusively past the angle of Treitz, supporting the term UE.
- Treatment with corticosteroids was ineffective; surgical resection and cladribine showed variable outcomes. Two patients developed enteropathy-associated T-cell lymphoma, and the overall mortality rate was 50%.
Conclusions:
- Ulcerative enteritis is a severe complication of celiac disease with a high risk of obstruction and bleeding.
- Corticosteroids are ineffective for UE.
- Treatment outcomes are variable, with a significant mortality rate, and further research is needed.
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