The following is a summary of “Revised Algorithmic Approach to Differentiate Between Nonspecific and Specific Etiologies of Chronic Terminal Ileitis,” published in the November 2023 issue of Gastroenterology by Sachdeva, et al.

Chronic isolated terminal ileitis (TI) presents challenges in distinguishing between specific etiologies like Crohn’s disease (CD) and intestinal tuberculosis (ITB) from nonspecific cases. For a study, researchers sought to refine an algorithm for improved differentiation between specific and nonspecific etiologies in patients with chronic isolated TI.

A retrospective review of patients with chronic isolated TI from 2007 to 2022 was conducted. A specific diagnosis (CD or ITB) was established using standardized criteria, and relevant data were collected. An existing algorithm was validated, and a revised algorithm incorporating clinical, laboratory, radiological, and colonoscopic findings was developed through multivariate analysis with bootstrap validation.

The study included 153 patients (mean age 36.9 ± 14.6 years, males—70%). Of these, 109 (71.2%) received a specific diagnosis (CD-69, ITB-40). The revised algorithm, validated with an optimism-corrected c-statistic of 0.975 and 0.958 with and without histopathological findings, respectively, demonstrated improved sensitivity, specificity, positive and negative predictive values, and overall accuracy: 98.2% (95% CI: 93.5–99.8), 75.0% (95% CI: 59.7–86.8), 90.7% (95% CI: 85.4–94.2), 94.3% (95% CI: 80.5–98.5), and 91.5% (95% CI: 85.9–95.4). This outperformed the previous algorithm (accuracy 83.9%, sensitivity 95.5%, specificity 54.6%).

The revised algorithm and multimodal approach achieved excellent diagnostic accuracy in stratifying patients with chronically isolated TI into specific and nonspecific etiologies. The enhancement could prevent missed diagnoses and unnecessary treatment side effects.

Source: journals.lww.com/ajg/abstract/2023/11000/revised_algorithmic_approach_to_differentiate.27.aspx