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INCREASING PREVALENCE OF INCIDENTAL ILEITIS FOLLOWING THE COVID-19 PANDEMIC

Santa Helou 1, Lamis Amer 1, Elio Mikhael 1, Rita Slim Karam 1, Joseph Amara 1, KHALIL HONEIN 1, Eid Mahfouz 1, Cesar Yaghi 1

Affiliations

1 Hotel Dieu de France Hospital - Saint Joseph University, Beirut, Lebanon

Summary

AI Generated

A retrospective study of 2164 colonoscopies found a significant increase in endoscopic and histologic terminal ileal inflammation in the period starting 2020 compared to before the Covid-19 pandemic, with rates rising from 0% to 5.8% for endoscopic ileitis and 3.4% to 11.4% for histologic abnormalities.

Endoscopic ileitis increased from 0% (pre-2020) to 5.8% (2020 onward), while abnormal ileal histology rose from 3.4% to 11.4%, both statistically significant.
All histologic subtypes increased significantly in the post-2020 period: active ileitis (2.8% to 9.9%), focal ileitis (1.5% to 6%), ulcerative ileitis (1.6% to 3.2%), and erosive ileitis (0.4% to 2.1%).
Nineteen patients in the post-2020 period were diagnosed with Crohn's disease based on ileitis findings, compared to zero in the earlier period.
The post-2020 period also showed improved procedural quality with higher ileum intubation rates (79.7% to 93.8%) and better bowel preparation (77.1% to 91.7%).
Authors speculate the increase may relate to Covid-19 virus effects, immune system changes, or vaccination, and express concern that granulomatous inflammation similar to Crohn's disease may lead to misdiagnosis.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

The incidental finding of terminal ileal inflammation during routine colonoscopy is not uncommon and is of unclear significance. It has been reported among asymptomatic persons undergoing non-diagnostic colonoscopy. There is limited data on long term follow-up and outcomes of such findings.(1)

Aims & Methods

This is a monocentric retrospective observational study spanning from 2018 to 2023, comparing two periods: the first period (P1) before the impact of the Covid-19 pandemic in 2020, and the second period (P2) starting 2020 reflecting the impact the pandemic left on colonoscopies. For each patient, variables were collected from medical records.

Results

Our initial database included 11200 colonoscopies, from which we randomly selected 2394 patients proportionally to the annual activity (mean of 1686/year before 2020 and 1189/year after 2020). Among indications of colonoscopy were screening and follow-up, change in bowel habits, anemia and bleeding. We excluded 287 patients (known history of inflammatory bowel disease and no ileum intubation). Then the sample was divided into P1 (681 patients) and P2 (1483 patients). Characteristics and findings are shown in Table 1. We noted better bowel preparation (77.1 vs 91.7%) and a higher ileum intubation in P2 (79.7 in P1 vs 93.8% in P2).

N=2164		P1 (N1=681)	P2 (N2= 1483)	p
Age (years)		57.5	56.9	NS
Overall endoscopic findings n(%)	Endoscopic aspect of ileitis	0 (0)	71 (5.8)	<0.001
	Abnormal ileal findings on histology	23 (3.4)	169 (11.4)	<0.001
	Diagnosis of Crohn's disease	0 (0)	19 (0.9)	<0.001
Overall histological findings n(%)	Active ileitis	19 (2.8)	147 (9.9)	<0.001
	Focal ileitis	10 (1.5)	89 (6)	<0.001
	Ulcerative ileitis	11 (1.6)	48 (3.2)	0.031
	Erosive ileitis	3 (0.4)	31 (2.1)	0.004
	Architectural distortion	1 (0.1)	16 (1.1)	0.023

Overall ileoscopy findings showed an increased aspect of ileitis on endoscopy (0% in P1 and 5.8% in P2, with p<0.001), correlating with a significant increase in the incidence of histological findings on ileal biopsies (3.4% in P1 vs 11.4% in P2; p<0.001). These histological findings included active, focal and ulcerative ileitis, with more architectural distortion. However, these results corresponded to a less severe ileitis (0.3 vs 2.3%; p=0.001). Nineteen of these patients with positive results of ileitis were diagnosed with Crohn’s disease.

Conclusion

This study showed an increase in endoscopic and histologic ileitis on colonoscopy following the Covid-19 era. This could be the result of the direct virologic effect that the virus has on intestinal inflammation, its indirect effect on immunity triggering the onset of enteritis, or the consequence of the mass vaccination campaign held to protect from the virus. Furthermore, histology showed granulomatous inflammation similar to Crohn’s disease, which may lead to misdiagnosis and probably overtreatment.

References

1. Agrawal M, Miranda MB, Walsh S, Narula N, Colombel JF, Ungaro RC. Prevalence and Progression of Incidental Terminal Ileitis on Non-diagnostic Colonoscopy: A Systematic Review and Meta-analysis. J Crohns Colitis. 2021 Feb 14;15(9):1455–63.

Conference

UEG Week Vienna 2024

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

SMALL INTESTINAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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