The ileum is the second half of the small intestine, after the duodenum and the jejunum. The terminal ileum (TI) is the very last part of the small intestine, where it joins onto the large intestine. It is inflamed in around half of patients with Crohn's disease. The TI is very close to the appendix, so inflammation in the TI is often mistaken for appendicitis.

Symptoms and Presentation of Ileal Disease

Crohn's Disease located only in the ileum is called Ileitis. Crohn's Disease located in the ileum and colon is called Ileocolitis. About 80% of patients with ileal involvement experience diarrhea with about five bowel movements per day being the average. Patients with ileal involvement often experience pain and cramping about 1-2 hours after a meal. Pain us usually around the periumbilical area (around the belly button) or the lower right quadrant.[1]


Nutrients continue to be absorbed here, most notably vitamin b12. This is not the only place in the digestive tract where B12 is absorbed but people with inflammation here (or who have had their ileum removed) may need supplements, either by injection, nasal spray or sublingual liquid, which is absorbed under the tongue. A blood test will determine B12 deficiency.

Also, although salt is passively absorbed throughout the small intestine, it is actively absorbed in the ileum. This means that if food is salty, salt can be absorbed throughout the small intestines, but if no salt is added to food, the ileum is required to absorb the small amounts naturally present in foods. Therefore if the ileum is inflamed, a low salt diet may lead to sodium deficiency, which can cause muscle fatigue and weakness. Symptoms are easily relieved by consuming something high in salt.


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