Endoscopic diagnosis of inflammatory bowel disease
- Michael A Roy, MD
Michael A Roy, MD
- Assistant Professor of Medicine
- Tufts University School of Medicine
- Section Editors
- Paul Rutgeerts, MD, PhD, FRCP
Paul Rutgeerts, MD, PhD, FRCP
- Section Editor — Inflammatory Bowel Disease
- Emeritus Professor of Medicine
- University Hospital, Leuven, Belgium
- John R Saltzman, MD, FACP, FACG, FASGE, AGAF
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
- Section Editor — Therapeutic and Diagnostic Endoscopy
- Professor of Medicine
- Harvard Medical School
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 . 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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- ILEOCOLONIC DISEASE
- Endoscopic findings in ulcerative colitis
- Backwash ileitis
- Endoscopic findings in Crohn disease
- ENDOSCOPY VERSUS RADIOGRAPHY IN ILEOCOLONIC IBD
- Barium studies
- Other radiologic tests
- ROLE IN DIFFERENTIAL DIAGNOSIS
- Infectious colitis and/or ileitis
- Pseudomembranous colitis
- NSAID ileitis
- Radiation colitis
- Ischemic colitis
- Colitis associated with diverticular disease
- Role of ileoscopy
- SMALL BOWEL DISEASE
- Wireless capsule endoscopy
- UPPER GASTROINTESTINAL DISEASE
- PERIRECTAL DISEASE
- Role of endosonography
- GENERAL CONSIDERATIONS
- Bowel preparation
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS