Quick Shot #13 Answer
Answer: Repeat Colonoscopy in 1 year
Mild terminal ileitis has a low (~1%) risk of progressing into clinically significant Crohn’s disease. In this asymptomatic patient there would be limited benefit in starting steroid medications or biologic due to limited risk of progression, diagnostic uncertainty and lack of end goal to treatment. 5ASA therapy has not been shown to be beneficial in CD. There have not been studies showing the value of inflammatory markers in these asymptomatic patients. If the patient is truly asymptomatic, it would be reasonable to monitor symptoms clinically and repeat and endoscopic evaluation in one year to assess for disease progression and to help guide management. In symptomatic patients, there is a higher risk of progression to overt CD.
- Jean A Donet, MD, Aline Charabaty, MD, Alan C Moss, MD, Management of Asymptomatic Terminal Ileitis, Crohn’s & Colitis 360, Volume 2, Issue 4, October 2020,
- Chang HS, Lee D, Kim JC, Song HK, Lee HJ, Chung EJ, Kim TH, Park HW, Byeon JS, Yang SK, Choe JW. Isolated terminal ileal ulcerations in asymptomatic individuals: natural course and clinical significance. Gastrointest Endosc. 2010 Dec;72(6):1226-32. doi: 10.1016/j.gie.2010.08.029. PMID: 21111872.
- Bezzio C, Arena I, Devani M, Omazzi B, Manes G, Saibeni S. Aspecific ileitis: Crohn’s disease or not Crohn’s disease? A prospective study. Int J Colorectal Dis. 2017 Jul;32(7):1025-1028. doi: 10.1007/s00384-017-2770-3. Epub 2017 Feb 4. PMID: 28161731.