Терминальный илеит: вопросы дифференциального диагноза и перспективы лечения - Журнал Терапевтический архив №4 Вопросы диагностики внутренних болезней 2025

Терминальный илеит: вопросы дифференциального диагноза и перспективы лечения

Осадчук А.М., Головенко О.В., Лоранская И.Д. Терминальный илеит: вопросы дифференциального диагноза и перспективы лечения. Терапевтический архив. 2025;97(4):378–385. DOI: 10.26442/00403660.2025.04.203196

© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.

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Osadchuk AM, Golovenko OV, Loranskaia ID. Terminal ileitis: Questions of differential diagnosis and prospects for treatment. A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2025;97(4):378–385. DOI: 10.26442/00403660.2025.04.203196

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Аннотация

Идиопатический терминальный илеит (ИТИ) встречается у 0,5–7% людей. Считается, что у части из них причина ИТИ может быть установлена со временем, у части из них развивается болезнь Крона, у большего числа пациентов ИТИ протекает бессимптомно и способен к саморазрешению. Диагностика причин развития терминального илеита трудна, а выбор терапевтической тактики сложен. Во многом это обусловлено отсутствием клинических рекомендаций по лечению ИТИ. Статья посвящена разработке алгоритма диагностики и лечения ИТИ, чем обусловлена ее актуальность. Показано, что при бессимптомном течении ИТИ лекарственная терапия не требуется, при наличии симптомного ИТИ с вовлечением только слизистой оболочки терминального отдела подвздошной кишки терапию следует начинать с назначение месалазина, а при выявлении трансмурального поражения стенки указанного отдела кишечника – с будесонида.

Ключевые слова: идиопатический терминальный илеит, месалазин, будесонид, болезнь Крона

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Idiopathic terminal ileitis (ITI) occurs in 0.5–7% of people. It is believed that in some of them the cause of ITI can be established over time, in some of them Crohn's disease develops, in a greater number of patients ITI is asymptomatic and capable of self-resolution. Diagnosis of the causes of terminal ileitis is difficult, and the choice of therapeutic tactics is complex. This is largely due to the lack of clinical guidelines for the treatment of ITI. The article is devoted to the development of an algorithm for the diagnosis and treatment of ITI, which determines its relevance. It is shown that in the case of asymptomatic ITI, drug therapy is not required, in the presence of symptomatic ITI involving only the mucous membrane, therapy should be started with the prescription of mesalazine, and if transmural damage to the wall of the terminal ileum is detected – with budesonide.

Keywords: idiopathic terminal ileitis, mesalazine, budesonide, Crohn's disease

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40. Li J, Ling F, Guo D, et al. The efficacy of mesalazine on nonspecific terminal ileal ulcers: A randomized controlled trial. Front Pharmacol. 2022;13:989654. DOI:10.3389/fphar.2022.989654
41. Agrawal M, Miranda MB, Walsh S, et al. Prevalence and progression of incidental terminal ileitis on non-diagnostic colonoscopy: A systematic review and meta-analysis. J Crohns Colitis. 2021;15(9):1455-63. DOI:10.1093/ecco-jcc/jjab030

________________________________________________

1. Iushchuk ND, Tseneva GIa, Karetkina GN, Brodov LE. Iersiniozy. Moscow: Meditsina, 2003 (in Russian).
2. Parfenov AI. Bolezni ileotsekal'noi oblasti. Moscow: Anakharsis, 2005 (in Russian).
3. Shestakova IV, Yushchuk ND. Chronic yersiniasis as a therapeutic problem. Terapevticheskii Arkhiv (Ter. Arkh.). 2010;3(82):71-6 (in Russian).
4. Mehta V, Gupta A, Mahajan R, et al. Symptomatic isolated terminal ileal ulcers: etiology and clinical significance. Endosc Int Open. 2017;5(7):E539-46. DOI:10.1055/s-0043-100688
5. Nandi N, Tai FWD, McAlindon M, Sidhu R. Idiopathic terminal ileitis: Myth or true entity? Curr Opin Gastroenterol. 2024;40(3):217-24. DOI:10.1097/MOG.0000000000001011
6. Koureta E, Karatzas P, Tampaki M, et al. Isolated nonspecific terminal ileitis: prevalence, clinical evolution and correlation with metachronous diagnosis of Crohn's disease: A retrospective study and review of the literature. Ann Gastroenterol. 2024;37(2):199-205. DOI:10.20524/aog.2024.0863
7. Bojic D, Markovic S. Terminal ileitis is not always Crohn’s disease. Ann Gastroenterol. 2011;24(4):271-5. PMID:24713761
8. Jeong SH, Lee KJ, Kim YB, et al. Diagnostic value of terminal ileum intubation during colonoscopy. J Gastroenterol Hepatol. 2008;23(1):51-5. DOI:10.1111/j.1440-1746.2007.05151.x
9. Reinisch S, Schweiger K, Pablik E, et al. An index with improved diagnostic accuracy for the diagnosis of Crohn's disease derived from the Lennard-Jones criteria. Aliment Pharmacol Ther. 2016;44(6):601-11. DOI:10.1111/apt.13727
10. Feakins R, Borralho Nunes P, Driessen A, et al. Definitions of histological abnormalities in inflammatory bowel disease: An ECCO position paper. J Crohns Colitis. 2024;18(2):175-91. DOI:10.1093/ecco-jcc/jjad142
11. Hamilton MJ, Makrauer FM, Golden K, et al. Prospective evaluation of terminal ileitis in a surveillance population of patients with ulcerative colitis. Inflamm Bowel Dis. 2016;22(10):2448-55. DOI:10.1097/MIB.0000000000000911
12. Moradi A, Mokhtarpour A, Yazdani A, et al. Algorithmic approach to inflammatory disorders of ileum. Iran J Pathol. 2022;17(4):381-94. DOI:10.30699/IJP.2022.539357.2736
13. Parfenov AI, Akopova AO, Shcherbakov PL, Mikcheeva OM. Role of video capsula endoscopy in the diagnostic algorithm of small bowel Crohn's disease. Terapevticheskii Arkhiv (Ter. Arkh.). 2019;91(4):37-42 (in Russian). DOI:10.26442/00403660.2019.04.000079
14. Parfenov AI, Kagramanova AV, Khomeriki SG, Kulakov D.S. Modern concept of differential diagnosis of colitis: from G.F. Lang to the present day. A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(12):1022-30 (in Russian). DOI:10.26442/00403660.2023.12.202496
15. Park SC, Chun HJ, Kang CD, Sul D. Prevention and management of non-steroidal anti-inflammatory drugs-induced small intestinal injury. World J Gastroenterol. 2011;17(42):4647-53. DOI:10.3748/wjg.v17.i42.4647
16. Chela H. Isolated terminal ileitis – Crohn’s disease or something else? J Gastro Hepato. 2024;10(13):1-6. DOI:10.47829/JJGH.2024.101303
17. Jenvrin A, Perret A, Palmieri LJ, et al. Chemotherapy-induced ileitis associated or not with colitis in digestive oncology patients: An AGEO multicentre study. Dig Liver Dis. 2023;55(10):1426-33. DOI:10.1016/j.dld.2023.03.001
18. Klimko A, Tieranu CG, Olteanu AO, et al. Capecitabine-induced terminal ileitis: Case report and literature review. Cureus. 2021;13(4):e14621. DOI:10.7759/cureus.14621
19. Goulart RA, Barbalho SM, Gasparini RG, de Carvalho AC. Facing terminal ileitis: Going beyond Crohn's disease. Gastroenterology Res. 2016;9(1):1-9.DOI:10.14740/gr698w
20. Barchi A, Vespa E, Passaretti S, et al. The dual lens of endoscopy and histology in the diagnosis and management of eosinophilic gastrointestinal disorders – A comprehensive review. Diagnostics (Basel). 2024;14(8):858. DOI:10.3390/diagnostics14080858
21. Choudhury A, Dhillon J, Sekar A, et al. Differentiating gastrointestinal tuberculosis and Crohn's disease – A comprehensive review. BMC Gastroenterol. 2023;23(1):246. DOI:10.1186/s12876-023-02887-016
22. Starkova DA. Mycobacterium avium as an actual pathogen of human mycobacteriosis. Russian Journal of Infection and Immunity. 2013;3(1):7-14 (in Russian). DOI:10.15789/2220-7619-2013-1-7-14
23. Griemert T, Siegel E, Brandstetter M, et al. Entamoeba histolytica-associated proctitis and ileitis mimicking Crohn's disease – A case report. Clin Case Rep. 2023;11(5):e6833. DOI:10.1002/ccr3.6833
24. Islam R, Leighton JA, Pasha SF. Evaluation and management of small-bowel tumors in the era of deep enteroscopy. Gastrointest Endosc. 2014;79(5):732-40. DOI:10.1016/j.gie.2013.11.003
25. Cahill C, Gordon PH, Petrucci A, et al. Small bowel adenocarcinoma and Crohn's disease: any further ahead than 50 years ago? World J Gastroenterol. 2014;20(33):11486-95. DOI:10.3748/wjg.v20.i33.11486
26. Waleed M, Perinkulam Sathyanarayanan S, Arif Maan S, et al. Terminal ileitis as the presenting feature of Henoch-Schönlein purpura in a 22-year-old male. Cureus. 2021;13(11):e19406. DOI:10.7759/cureus.19406
27. Hatemi I, Hatemi G, Çelik AF. Systemic vasculitis and the gut. Curr Opin Rheumatol. 2017;29(1):33-8. DOI:10.1097/BOR.0000000000000344
28. Babakhanlou R, Ravandi-Kashani F, Kontoyiannis DP. Neutropenic enterocolitis: An uncommon, but fearsome complication of leukemia. J Hematol. 2023;12(2):59-65. DOI:10.14740/jh1105
29. Harb AH, Abou Fadel C, Sharara AI. Radiation Enteritis. Curr Gastroenterol Rep. 2014;16:383. DOI:10.1007/s11894-014-0383-3
30. Nakamura M, Yamamura T, Maeda K, et al. Clinical features of ischemic enteritis diagnosed by double-balloon endoscopy. Can J Gastroenterol Hepatol. 2021;2021:8875564. DOI:10.1155/2021/8875564
31. Songtanin B, Chen JN, Nugent K. Microscopic colitis: Pathogenesis and diagnosis. J Clin Med. 2023;12(13):4442. DOI:10.3390/jcm12134442
32. Prakash A, Markham A. Oral delayed-release mesalazine: A review of its use in ulcerative colitis and Crohn's disease. Drugs. 1999;57(3):383-408. PMID:10193690
33. Kumar R, Nath P, Anand AC, et al. Combination of antimicrobials for non-specific isolated terminal ileal abnormalities – A randomized clinical trial. Indian J Gastroenterol. 2023;42(5):658-67. DOI:10.1007/s12664-023-01398-w
34. Dignass A, Marteau Р. Mesalamine in the treatment of active Crohn’s disease. Gastroenterology. 2005;128(1):245-6. DOI:10.1053/j.gastro.2004.11.030
35. Tamura S, Ishida N, Miyazu T, et al. Mesalazine granule formulation improves clinical data in Crohn's disease compared with tablet formulation. Sci Rep. 2020;10:21353. DOI:10.1038/s41598-020-78603-9
36. Sun KW. Mesalamine and immunosuppressant treatment in Crohn’s disease. The Minnesota Undergraduate Research & Academic Journal. 2022;5(4):1-12. Available at: https://pubs.lib.umn.edu/index.php/muraj/article/view/4024/3105. Accessed: 05.12.2024.
37. Shelygin YuA, Ivashkin VT, Achkasov SI, et al. Clinical guidelines. Crohn’s disease (К50), adults. Koloproktologia. 2023;22(3):10-49 (in Russian). DOI:10.33878/2073-7556-2023-22-3-10-49
38. Wan J, Wang X, Zhang Y, et al. 5-Aminosalicylic acid prevents disease behavior progression and intestinal resection in colonic and ileocolonic Crohn's disease patients: A retrospective study. Can J Gastroenterol Hepatol. 2021;2021:1412663. DOI:10.1155/2021/141266
39. Donet JA, Charabaty A, Moss AC. Management of asymptomatic terminal ileitis. Crohns Colitis 360. 2020;2(4):otaa065. DOI:10.1093/crocol/otaa065
40. Li J, Ling F, Guo D, et al. The efficacy of mesalazine on nonspecific terminal ileal ulcers: A randomized controlled trial. Front Pharmacol. 2022;13:989654. DOI:10.3389/fphar.2022.989654
41. Agrawal M, Miranda MB, Walsh S, et al. Prevalence and progression of incidental terminal ileitis on non-diagnostic colonoscopy: A systematic review and meta-analysis. J Crohns Colitis. 2021;15(9):1455-63. DOI:10.1093/ecco-jcc/jjab030

Авторы

А.М. Осадчук*, О.В. Головенко, И.Д. Лоранская

ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*a.m.osadchuk2020mail.ru

________________________________________________

Alexey M. Osadchuk*, Oleg V. Golovenko, Irina D. Loranskaia

Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*a.m.osadchuk2020mail.ru

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