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Challenging question: can we diagnose Crohn's disease without histology?

Anne M Griffiths1

  • 1Division of Gastroenterology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ont., Canada.

Digestive Diseases (Basel, Switzerland)
|September 14, 2013
PubMed

Insights

Diagnosing Crohn's disease (CD) requires multiple tests, not just one. A combination of imaging, serology, endoscopy, and histology confirms CD, especially when symptoms are compatible.

Area of Science:

  • Gastroenterology
  • Internal Medicine
  • Pathology

Background:

  • Diagnosing Crohn's disease (CD) typically involves a multi-faceted approach.
  • Currently, no single diagnostic test definitively identifies CD.
  • Clinical presentation, alongside various investigations, forms the basis for diagnosis.

Purpose of the Study:

  • To emphasize the continued importance of a combined diagnostic strategy for Crohn's disease.
  • To highlight the role of histology in specific diagnostic scenarios.
  • To maintain current diagnostic recommendations for suspected CD.

Main Methods:

  • Review of current diagnostic conventions for Crohn's disease.
  • Analysis of the contribution of different investigative modalities (imaging, serology, endoscopy, histology).
  • Evaluation of histology's role in relation to macroscopic disease presentation.

Main Results:

  • Histology is often 'compatible with' rather than 'diagnostic of' CD.
  • The diagnostic value of histology is site-dependent.
  • Histology is crucial for differentiating inflammatory bowel disease types in colonic involvement and confirming CD in atypical locations.

Conclusions:

  • The conventional diagnostic approach combining multiple investigations for Crohn's disease remains essential.
  • Histology plays a critical, albeit variable, role, particularly in colonic disease and atypical presentations.
  • Maintaining this integrated diagnostic strategy ensures accurate identification of Crohn's disease.

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