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Crohn's disease. Diagnostic procedures and problems.

E Lind, O Fausa, K Elgjo

    Scandinavian Journal of Gastroenterology
    |August 1, 1985
    PubMed
    Summary
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    Diagnosing Crohn's disease (CD) requires multiple methods. While radiology and endoscopy are useful, surgical specimen histology offers the highest diagnostic accuracy for intestinal CD.

    Area of Science:

    • Gastroenterology
    • Internal Medicine
    • Pathology

    Background:

    • Crohn's disease (CD) is a chronic inflammatory bowel disease affecting any part of the gastrointestinal tract.
    • Accurate diagnosis is crucial for effective management and treatment of CD.
    • Diagnostic challenges exist, particularly in differentiating CD from other bowel conditions.

    Purpose of the Study:

    • To evaluate the diagnostic efficacy of radiological, endoscopic, and histological methods in patients with Crohn's disease.
    • To compare the diagnostic yield of biopsy versus surgical specimens in identifying CD.
    • To analyze initial symptoms in patients misdiagnosed with ulcerative colitis who later presented with CD.

    Main Methods:

    • Retrospective analysis of 214 patients diagnosed with Crohn's disease.

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  • Investigation included radiological imaging, endoscopy, and histological examination of biopsy and surgical specimens.
  • Comparison of diagnostic findings across different methods and affected bowel segments (small vs. large bowel).

    • Main Results:

    • Radiological findings were positive in all small-bowel CD cases but less than half of large-bowel CD.
    • Endoscopy was conclusive in 36% (small bowel) to 91% (small and large bowel) of cases.
    • Histology of biopsy specimens was conclusive in <33%, while operative specimens were conclusive in 90-100% of patients.
    • Multiple biopsy specimens can reveal Crohn-specific lesions even in endoscopically normal mucosa.

    Conclusions:

    • Histological examination of surgical specimens provides the highest diagnostic accuracy for Crohn's disease.
    • Endoscopy is highly effective for large-bowel CD and combined small- and large-bowel disease.
    • Radiology is sensitive for small-bowel CD but less so for large-bowel involvement.
    • Careful histological examination of multiple biopsies is essential for definitive CD diagnosis.