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Endoscopy in Crohn's Disease

Endoscopy in Crohn's Disease Overview

Patient Comments

Unfortunately, there is no simple lab test that allows a definitive diagnosis of Crohn's disease. If a person has symptoms suggesting inflammatory bowel disease, their primary care professional or gastroenterologist will probably recommend endoscopy ("scope").

Endoscopy is a test in which a thin tube with a light and a tiny camera at the end is inserted into your digestive tract. The camera transmits pictures back to a video monitor, where they are magnified so the doctor can see exactly what the inside of the digestive tract looks like. The endoscope shows ulcers, bleeding, and other signs of Crohn's disease and indicates the location and extent of the disease within the digestive tract.

With endoscopy, the doctor can tell whether a person has Crohn's disease or a similar condition called ulcerative colitis (or some other condition). Ulcerative colitis, like Crohn's disease, an inflammatory bowel disease. Ulcerative colitis, like Crohn's disease, affects one section of the large intestine (colon) only, while Crohn's disease is more likely to affect the small intestine and often attacks different parts of the digestive tract with normal tissue in between ("skip lesions").

Doctors have different names for endoscopy depending on which part of the digestive tract they are examining.

  • Esophagogastroduodenoscopy (EGD): Also called upper endoscopy, this test examines the lining of the esophagus (the tube between the mouth and stomach), the stomach, and the duodenum (the upper part of the small intestine).
  • Colonoscopy: This test examines the lining of the colon, or large intestine, and sometimes the lower part of the ileum (the lowest part of the small intestine).
  • Sigmoidoscopy: This test examines the lining of the lowest third of the colon, which includes the rectum. The name of the test derives from a bend called the sigmoid in this part of the colon.
  • Endoscopic retrograde cholangiopancreatography (ERCP): This test combines endoscopy with X-rays to examine the ducts that open into the small intestine from the liver, gallbladder, and pancreas. In some people with Crohn's disease, these ducts become inflamed and close up.
  • Endoscopic ultrasound: This test combines endoscopy with ultrasound, a technology that uses sound waves to create images of organs deep within the body. (This is the same safe technology used to look at a fetus in its mother's womb.) This technique is widely used in the United States to evaluate fistulas, a common complication of inflammatory bowel disease.
  • Balloon endoscopy, or enteroscopy is an endoscopic procedure that allows the physician to visualize the entire small intestine and take tissue biopsies.
  • Capsule endoscopy (wireless endoscopy) is an endoscopic procedure in which a small video capsule is swallowed by the patient. The video capsule takes photographs of the inside of the esophagus, stomach, and small intestine. The drawbacks of capsule endoscopy include: 1) areas missed due to the rapid transit of the capsule, 2) battery failure, 3) inability to take tissue biopsies, 4) the capsule becoming stuck or lodged in strictures or tumors, and 5) the camera takes tens of thousands of photographs that becomes very time consuming for the the health care professional to review.

X-rays may also be ordered. These may include a barium swallow (upper GI series) or a barium enema (lower GI series).

Which of these tests your doctor chooses to do depends on the symptoms the patient has. Generally, the patient's symptoms suggest what part of the digestive tract is involved. For example, nausea, vomiting, and indigestion (dyspepsia) suggest that the upper part of the GI tract is affected, and an EGD would probably be performed. Rectal bleeding or pain with bowel movements, on the other hand, suggests that the lowest part of the GI tract is affected, and a sigmoidoscopy would probably be the first procedure ordered. Because colonoscopy allows examination of the lowest part of the small intestine, as well as the colon, this is the usual test of choice when Crohn's disease is suspected.

Endoscopy allows the doctor to not only see the inside of the digestive tract, but also to take small samples (biopsies) of tissue for further examination under a microscope. This can help confirm the diagnosis and show the extent of the disease. In some cases, endoscopy can also be used for therapy. The doctor can use the endoscope to open a duct or remove a gallstone (ERCP).

Medically Reviewed by a Doctor on 3/31/2015
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Endoscopy in Crohn's Disease - Type

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Read What Your Physician is Reading on Medscape

Crohn Disease »

Crohn disease is an idiopathic, chronic, transmural inflammatory process of the bowel that often leads to fibrosis and obstructive symptoms, which can affect any part of the gastrointestinal (GI) tract from the mouth to the anus.

Read More on Medscape Reference »

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