Ileitis

Gl Dry mouth nausea nonspecific Gl symptoms inflammatory bowel disease bleeding and inflammation of the gums hepatitis pancreatitis colitis ileitis ... 

Therapeutic pyramid approach to inflammatory bowel diseases. Treatment choice is predicated on both the severity of the illness and the responsiveness to therapy. Agents at the bottom of the pyramid are less efficacious but carry a lower risk of serious adverse effects. Drugs may be used alone or in various combinations. Patients with mild disease may be treated with 5-aminosalicylates (with ulcerative colitis or Crohn s colitis), topical corticosteroids (ulcerative colitis), antibiotics (Crohn s colitis or Crohn s perianal disease), or budesonide (Crohn s ileitis). Patients with moderate disease or patients who fail initial therapy for mild disease may be treated with oral corticosteroids to promote disease remission immunomodulators (azathioprine, mercaptopurine, methotrexate) to promote or maintain disease remission or anti-TNF antibodies. Patients with moderate disease who fail other therapies or patients with severe disease may require intravenous corticosteroids, anti-TNF antibodies, or surgery. Natalizumab is reserved for patients with severe Crohn s disease who have failed immunomodulators and TNF antagonists. Cyclosporine is used primarily for patients with severe ulcerative colitis who have failed a course of intravenous corticosteroids. TNF, tumor necrosis factor. 

While glucocorticoids may have a beneficial effect on regional ileitis, perforation of the ileum, lymphatic dilatation, and microscopic fistulae have been observed after treatment. 

In a randomized, multicenter study in 94 patients, mesalazine 4 g/day for 12 weeks in a microgranular formulation was as effective as a standard dose of a glucocorticoid (6-methylpredisolone 40 mg/day) in mild to moderate Crohn s ileitis (Crohn s Disease Activity Index 180-350) (9). The group treated with methylpredisolone had a higher number of adverse events than those given mesalazine. The only adverse effect related to mesalazine was acute pancreatitis, which resolved on withdrawal. 

Prantera C, Cottone M, Pallone F, Annese V, Franze A, Cerutti R, Bianchi Porro G. Mesalamine in the treatment of mild to moderate active Crohn s ileitis results of a randomized, multicenter trial. Gastroenterology 1999 116(3) 521-6. 

Regional ileitis is an inflammation of the part of the small intestine where it connects with the large intestine (colon). The area becomes scarred and an intestinal obstruction often develops. This may require emergency surgery to correct. 

It is interesting to note that regional ileitis is more common among the higher socioeconomic groups. These are the folks who are more likely to take the advice of doctors and dentists seriously and thus are more susceptible to the propaganda of the tooth fairies of the ADN. 

McVey DC, Schmid PC, Schmid HH, Vigna, SR (2003) Endocannabinoids induce ileitis in rats via the capsaicin receptor (VRl). J Pharmacol Exp Ther 304 713-722... 

Finally, it should be noted that anandamide and 2-AG have been shown to stimulate intestinal primary sensory neurons via the VRl receptor to release substance P, resulting in ileitis in rats (McVey et al. 2003) and that endocannabinoids may mediate the inflammatory effects of toxin A. Thus, in fhe intestinal mucosa, endocannabinoids may have both a protective role (via CBi receptor activation) and produce deleterious effects (via VRl receptor activation, presumably at higher concentrations). 

The first-line of treatment for mild to moderate ulcerative colitis or Crohn s colitis consists of oral sulfasalazine or mesalamine mesalamine or steroid enemas may be used for rectosigmoid disease. Delayed-release oral formulations of mesalamine may be used for Crohn s ileitis. 

Ulcerative colitis is confined to the rectum and colon, and affects the mucosa and the submucosa. In some instances, a short segment of terminal ileum may be inflamed this is referred to as backwash ileitis. Unlike Crohn s disease, the deeper longitudinal muscular layers, serosa, and regional lymph nodes are not usually involved. Fistulas, perforation, or obstruction are uncommon because inflammation is usually confined to the mucosa and submucosa. 

Systemic complications of Crohn s disease are common, and similar to those found with ulcerative colitis. Arthritis, iritis, skin lesions, and liver disease often accompany Crohn s disease. Renal stones occur in up to 10% of patients with Crohn s disease (less frequently with ulcerative colitis) and are caused by fat malabsorption, which allows for greater oxalate absorption and formation of calcium oxalate stones. Gallstones also occur with greater frequency in patients with ileitis, possibly because of bile acid malabsorption at the terminal ileum. 

Distribution Mouth to anus Rectum — colon back-wash ileitis... 

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