Small bowel imaging in Crohn's disease patients

Area of Science:

• Gastroenterology
• Medical Imaging
• Inflammatory Bowel Disease

Background:

• Crohn's disease (CD) is a chronic inflammatory bowel disorder affecting the small bowel (SB).
• Diagnosis often relies on conventional endoscopy, but inaccessible SB segments pose challenges.
• CD can present with inflammatory or complicated disease, including strictures and fistulas.

Purpose of the Study:

• To review and compare endoscopic and radiologic modalities for diagnosing and assessing Crohn's disease.
• To evaluate the sensitivity, specificity, side-effects, and limitations of various diagnostic techniques.
• To provide a clinical guide for selecting appropriate tests for small bowel Crohn's disease.

Main Methods:

• Review of current endoscopic techniques: esophagogastroduodenoscopy, ileocolonoscopy, video capsule endoscopy, and enteroscopy.
• Review of radiologic techniques: computed tomographic enterography, magnetic resonance enterography, and ultrasonography.
• Evaluation of diagnostic performance, including sensitivity and specificity, and assessment of side-effects and limitations.

Main Results:

• Both endoscopic and radiologic modalities are crucial for diagnosing CD, determining disease extent, and monitoring treatment response.
• Advanced endoscopic and radiologic techniques can assess SB segments not reachable by conventional methods.
• Imaging aids in detecting active inflammation, complications like strictures and fistulas, and extraintestinal manifestations.

Conclusions:

• A comprehensive understanding of imaging modalities is essential for effective Crohn's disease management.
• The choice of diagnostic test depends on the clinical context, aiming for optimal reliability and safety.
• This review serves as a guide for clinicians to select the most appropriate imaging test for individual patients.