Endoscopy in Crohn's Disease
Noel Williams, MD
Kathryn L Hale, MS, PA-C
Simmy Bank, MD, MB, ChB
Francisco Talavera, PharmD, PhD
BS Anand, MD
Endoscopy in Crohn's Disease Overview
Unfortunately, there is no simple lab test that allows a definitive diagnosis of Crohn's disease. If you have symptoms suggesting inflammatory bowel disease, your primary care provider 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 your doctor can see exactly what the inside of your 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, your doctor can tell whether you have Crohn's disease or a similar condition called ulcerative colitis (or some other condition). Ulcerative colitis is, like Crohn's disease, an inflammatory 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 looking at.
None of these tests allows the doctor to see the entire small intestine. Newer tests are being developed that will show more of the small intestine. For now, a combination of endoscopy and x-ray tests is used to diagnose Crohn's disease. The x-rays may include an “upper GI series,” “small bowel follow-through,” and lower GI series, or barium enema.
Which of these tests your doctor chooses to do depends on the symptoms you have. Your symptoms suggest which part of your digestive tract is involved. For example, nausea and vomiting and dyspepsia suggest that the upper part of the tract is affected, and an EGD would probably be done. Rectal bleeding or pain with bowel movements, on the other hand, suggests that the lowest part of the tract is affected, and a sigmoidoscopy would probably be the first choice of test. 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).
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