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
Venkatachala Mohan, MD
Endoscopy in Crohn's Disease Overview
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.
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).
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