Clinical features and differential diagnosis in symptomatic localized terminal ileitis or ulcer

Despite advancements in diagnostic techniques, the accurate identification and management of localized terminal ileitis or ulcers (LTIU) remains challenging, with a wide range of associated diseases presenting with similar clinical and endoscopic features. This retrospective observational study aimed to determine the etiology and discrimination of various diseases in patients with symptomatic LTIU. Data on demographics, clinical manifestations, and endoscopic findings were collected and analyzed statistically using descriptive and inferential methods, including frequency analysis and chi-square tests. Among the 224 patients who underwent LTIU on ileocolonoscopy, 110 (49.1%) had symptoms, of which 71 (64.5%) had specific etiologies on initial testing and after 6 months of follow-up. Definitive diagnoses were ascertained, with Crohn disease (CD) and Behçet disease (BD) being the most common diseases in this cohort, accounting for 27.3% (30 patients) and 18.2% (20 patients) of cases, respectively. Other diagnoses included infectious enteritis in 10 (9.1%) patients, drug-induced enteropathy in 5 (4.5%), intestinal tuberculosis in 5 (4.5%), and lymphoma in 1 (0.9%). Additionally, 39 patients (35.5%) had nonspecific ulcers. After 1 year of treatment, symptomatic and endoscopic resolution was noted in 7 out of 30 patients (23.3%) with CD and 10 out of 20 (50.0%) with BD. Of the 39 patients initially diagnosed with nonspecific ulcers with persistent symptoms, 2 were eventually diagnosed with CD. The high proportion of diagnosed diseases among symptomatic patients with LTIU underscores the importance of early and accurate diagnosis in guiding appropriate treatment strategies. These findings highlight the need for further research to refine diagnostic approaches and optimize patient outcomes in this challenging clinical scenario.