From the Guidelines
The most common causes of ileitis are Crohn's disease, infections, and medications, with Crohn's disease being the leading cause, as it is characterized by chronic inflammation that can affect any part of the gastrointestinal tract, frequently involving the terminal ileum. According to the European consensus on the histopathology of inflammatory bowel disease 1, the precise etiology of ileitis is unknown, but it is believed to arise from an interaction between genetic and environmental factors. The 2018 consensus recommendations for evaluation, interpretation, and utilization of computed tomography and magnetic resonance enterography in patients with small bowel Crohn's disease 1 highlight the importance of imaging findings in diagnosing ileitis, including segmental mural hyperenhancement, asymmetric wall thickening, and stratified or bi- or tri-laminar patterns.
Some of the key causes of ileitis include:
- Crohn's disease, which can cause chronic inflammation and damage to the ileum
- Infectious ileitis, commonly caused by pathogens such as Yersinia enterocolitica, Salmonella, Campylobacter, and Mycobacterium tuberculosis
- Medication-induced ileitis, resulting from NSAIDs like ibuprofen or naproxen through direct mucosal damage
- Ischemic ileitis, occurring when blood flow to the ileum is compromised, often due to atherosclerosis, thromboembolism, or vasculitis
- Less common causes, including radiation enteritis, NSAID enteropathy, and systemic conditions like Behçet's disease, systemic lupus erythematosus, and sarcoidosis.
Diagnosis and treatment of ileitis depend on the underlying cause, and may involve a combination of clinical evaluation, laboratory tests, imaging studies, and sometimes endoscopy with biopsy, as well as antibiotics, immunosuppressive medications, or discontinuation of offending medications 1.
From the Research
Causes of Ileitis
The causes of ileitis, or inflammation of the ileum, can be diverse and include:
- Infectious diseases
- Spondyloarthropathies
- Vasculitides
- Ischemia
- Neoplasms
- Medication-induced ileitis
- Eosinophilic enteritis
- Crohn's disease, which is a common cause of ileitis 2
Clinical Presentation
The clinical presentation of ileitis can vary from an acute and self-limited form to a chronic and debilitating course, depending on the underlying cause. Symptoms may include right lower quadrant pain and/or diarrhea, and in some cases, obstructive symptoms, hemorrhage, and/or extraintestinal manifestations 2
Diagnosis and Treatment
Distinguishing between the various forms of ileitis remains a challenge and requires a detailed history and physical examination, laboratory testing, and ileocolonoscopy and/or radiologic data. Treatment options may include medications such as mesalamine, sulfasalazine, corticosteroids, and budesonide, as well as surgery in some cases 2, 3, 4, 5, 6
Specific Causes and Treatments
Some specific causes of ileitis, such as Crohn's disease, may require treatment with steroids, monoclonal antibody therapies, immunomodulators, and surgery 4. Other causes, such as infectious diseases, may require antibiotic treatment. Medication-induced ileitis may require discontinuation of the offending medication 2