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Endoscopic diagnosis of inflammatory bowel disease

Michael A Roy, MD
Section Editors
Paul Rutgeerts, MD, PhD, FRCP
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Gastrointestinal (GI) endoscopy has a pivotal role in the diagnosis of suspected inflammatory bowel disease (IBD) [1-6]. Colonoscopy with ileoscopy, esophagogastroduodenoscopy (EGD), and enteroscopy can usually differentiate between IBD and its mimics, particularly when augmented by results of histopathology. In addition, other modalities such as endoscopic ultrasonography have considerable utility in the diagnosis and evaluation of complicated anorectal Crohn disease and in the differentiation of ulcerative colitis from Crohn’s colitis [7]. Beyond its diagnostic utility, GI endoscopy has an important role in the staging of severity of disease, evaluation and treatment of strictures, detection of postoperative recurrence, assessment of the efficacy of medical therapy, surveillance for neoplasms, and preoperative assessment, particularly in Crohn disease.

This topic will review the diagnostic accuracy of GI endoscopy, the major endoscopic findings that may be seen in patients with IBD, and some practical considerations regarding endoscopy in patients with suspected IBD. The current challenge is to select patients who will benefit from endoscopy, and to decide when to use other diagnostic modalities either in combination with or instead of endoscopy. The clinical manifestations and treatment of the different forms of this disorder are discussed separately. (See "Clinical manifestations, diagnosis and prognosis of Crohn disease in adults" and "Overview of the medical management of mild to moderate Crohn disease in adults" and "Surgical management of ulcerative colitis" and "Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults" and "Management of severe ulcerative colitis in adults" and "Management of mild to moderate ulcerative colitis in adults".)


Endoscopic findings in ulcerative colitis — Endoscopy in ulcerative colitis (UC) typically reveals the following:


Edema/loss of the usual fine vascular pattern

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Literature review current through: Nov 2017. | This topic last updated: Apr 04, 2016.
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