Most Common Cause of Jejunitis
Campylobacter jejuni is the most common infectious cause of jejunitis worldwide, particularly in the context of acute gastroenteritis with small bowel involvement. 1
Primary Infectious Etiology
C. jejuni represents the most frequent bacterial pathogen causing community-acquired acute bacterial diarrhea and associated small bowel inflammation, typically beginning in the small bowel and progressing distally to involve the cecum and colon 1
The organism causes gastroenteritis with fever, abdominal pain, and watery diarrhea, though it can occasionally present as pancolitis mimicking inflammatory bowel disease 1
C. jejuni is globally recognized as a major trigger of gastrointestinal disease, with significant morbidity from post-infectious sequelae including Guillain-Barré syndrome, reactive arthritis, and irritable bowel syndrome 2
Geographic and Clinical Context
In regions like India and Bangladesh, gastroenteritis (predominantly from C. jejuni) is the most frequent antecedent event preceding various complications, occurring in 36-47% of cases 3
Upper respiratory tract infections are more common antecedent events in Europe, North America, and parts of Asia (22-53% of cases), but when jejunitis specifically occurs, C. jejuni remains the predominant bacterial cause 3, 4
The organism is particularly prevalent in areas with compromised hygienic infrastructure, with frequencies reaching 60-70% in regions like Curaçao, China, and Bangladesh 3
Important Differential Considerations
While C. jejuni is the most common cause, other etiologies must be considered based on clinical presentation:
Celiac disease-related ulcerative enteritis (more appropriately termed than "ulcerative jejunitis") presents with obstruction, GI hemorrhage, or malabsorption, typically in older adults with known or undiagnosed celiac disease 5
Clostridium difficile has been implicated in duodenitis-proximal jejunitis, particularly in equine medicine, though human cases are less well-documented 6
Other bacterial pathogens including Salmonella, Yersinia, and E. coli O157:H7 can cause segmental colitis with small bowel involvement 1
Clinical Pitfalls
C. jejuni jejunitis is clinically indistinguishable from other bacterial gastroenteritides, requiring empiric fluoroquinolone therapy, though increasing antibiotic resistance is problematic 2
Rare presentations include meningitis in immunocompromised patients or those with CNS comorbidities, requiring high clinical suspicion and molecular diagnostic methods 7
In immunocompromised patients, consider cytomegalovirus as an alternative cause, which carries high mortality if misdiagnosed 4