Diffuse duodenitis associated with ulcerative colitis

Backwash ileitis and postcolectomy pouchitis are well-recognized complicati ons of ulcerative colitis (UC), whereas inflammation of the proximal small intestine is not. In contrast, small intestinal disease at any level is com mon in Crohn's disease (CD). Despite this well-established and accepted dog ma, rare cases of histologically proven diffuse duodenitis (DD) associated with UC appear in the literature. In this study, we report our experience w ith similar cases exhibiting this unusual inflammatory phenomenon. Routine histologic sections from four cases of DD associated with well-documented U C were reviewed and the findings correlated with all available medical reco rds. Multiple endoscopic biopsies showing histologic features of UC and col ectomy specimens confirming severe ulcerative pancolitis were available for all cases. Varying degrees of active chronic inflammation and architectura l mucosal distortion identical to UC were observed in pre- and postcolectom y duodenal biopsies of one of four and four of four cases, respectively. Si milar inflammatory patterns were present postoperatively in the ileum in th ree of four cases and in the jejunum in one case. Endorectal pull-through ( ERPT) procedures were performed in three of four patients and an end-to-end ileorectal anastomosis was done in one patient. Despite extensive upper ga strointestinal tract involvement, none of the patients developed postsurgic al Crohn's-like complications during a follow-up period of 12 to 54 months. This suggests that patients with pancolitis and DD do not necessarily have CD, but rather may have UC and, most importantly, that successful ERPT pro cedures may be performed in these patients.