Chronic ulcerative non-granulomatous jejunoileitis

　　1, Etiology

　　The etiology is unknown. In some patients with celiac disease, symptoms improve after being given gluten-free food, but after developing chronic ulcerative jejunitis, gluten-free food no longer relieves symptoms. The relationship between the two is not clear.

　　2, Pathogenesis

　　In surgical specimens or autopsies, multiple ulcers can be seen in the jejunum and ileum, with flat or normal mucosa between the ulcers. Under the microscope, the ulcer site shows infiltration of lymphocytes, plasma cells, and multinucleated cells, and there may also be an increase in eosinophils. The intestinal wall may have patchy thickening without granulomas. The inflammatory infiltration and ulcers can extend to the full thickness of the intestinal wall.

　　The disease is prone to complications such as hemorrhage, perforation, secondary infection, and multiple abscesses. The course of the disease is generally severe and progresses rapidly, and the patient may die from complications within 1 to 2 years. The amount and speed of bleeding depend on the type and diameter of the eroded blood vessels, the state of vasoconstriction and vasodilation, and the patient's coagulation mechanism. Capillary bleeding can reach 5 to 10 ml per day, which can be detected as occult blood in feces. The positive result can be caused by hemoglobin, myoglobin in the diet, or catalase from plants.

　　The main symptoms include diarrhea, watery stools, a long course of illness, and a history of diarrhea often dating back to childhood. During the course of the disease, there may be relief periods ranging from several days to several months, during which the patient is healthy and asymptomatic. However, it eventually develops into chronic persistent diarrhea. Some patients may start with steatorrhea or develop it later. Abdominal pain is also a common symptom, usually severe colicky pain. If hypoproteinemia occurs, it is often accompanied by edema of the extremities. The disease is also prone to intestinal bleeding and obstruction, often becoming the reason for the first visit. Systemic symptoms include fever, weight loss, and significant emaciation. Physical examination shows cachexia, abdominal distension, hyperactive bowel sounds, visible intestinal patterns, mild tenderness in the abdomen, and signs of acute peritonitis such as rebound tenderness if there is a perforation of an ulcer.

　　Excessive sexual activity is detrimental to the recovery of ulcerative nonspecific jejunoileocolitis, as fatigue is one of the important factors that trigger the disease. Patients in the progressive stage should not get pregnant, as studies have confirmed that pregnancy can trigger or exacerbate the condition. There are theories of onset such as infection, heredity, mental factors, and allergies, but none can fully explain the whole picture of ulcerative colitis. The following are possible etiological theories of chronic ulcerative nonspecific jejunoileitis.

　　1. Barium X-ray Examination

　　The small intestine shows segmentation; ulcers may not be found; narrowing and dilation of the bowel; segmental folds are irregular or thickened.

　　2. Small Bowel Endoscopy

　　Multiple ulcers are visible in the jejunum and ileum, with the mucosa between the ulcers becoming flat or normal.

　　3. Mucosal Biopsy

　　The mucosa becomes flat, indistinguishable from celiac disease, and is not helpful for differential diagnosis.

　　What kind of food is good for patients with chronic ulcerative nonspecific jejunoileitis

　　Diet should include foods rich in protein, such as lean meat, beef, mushrooms, jujube, sesame, etc. In addition, food for the prevention and treatment of deficiency syndromes includes black fungus, yam, coriander, chive, eggplant,芡实, water chestnut, lotus root, fennel, lychee, chicken, lamb, fig, etc.

　　1. Treatment

　　Gluten-free diet is ineffective; antibiotics are ineffective. It is reported that prednisone (prednisone) at a dose of 40 to 80mg per day can alleviate the condition of some patients, but the long-term effects are yet to be evaluated in the future.

　　2. Prognosis

　　The prognosis is poor, and most patients die within 1 to 5 years after the onset (persistent refractory diarrhea). The causes of death include intestinal perforation and peritonitis, multiple abscesses and sepsis, uncontrollable intestinal bleeding, and chronic failure, etc.