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Inflammatory Bowel Disease
New Techniques in the Diagnosis of Inflammatory Bowel Disease
a report by
Shabana F Pasha, MD and Jonathan A Leighton, MD
Division of Gastroenterology and Hepatology, Mayo Clinic College, Scottsdale, Arizona
Inflammatory bowel disease (IBD) defines a group of inflammatory tomography enterography (CTE), and magnetic resonance enterography
disorders of the gastrointestinal tract, classified as Crohn’s disease (CD), (MRE)—showed that CE had a significantly higher diagnostic yield in CD
ulcerative colitis (UC), and indeterminate colitis (IC). IC does not fulfil the patients.
6
The yield for CE versus SBFT was 63 and 23%, respectively
criteria for diagnosis of CD or UC. The diagnosis of IBD can pose a (weighted incremental yield (IYw) 40%); yield for CE versus ileoscopy was
significant challenge to gastroenterologists, mainly due to a wide array of 61 and 46%, respectively (IYw 15%); yield for CE versus CTE was 69 and
clinical presentations that are related to the involvement of different 30%, respectively (IYw 38%); and yield for CE versus PE was 46 and 8%,
portions of the gastrointestinal tract. Due to an absence of uniformity in respectively (IYw 38%). Subanalysis of the data showed a significantly
clinical presentation and a lack of a single gold standard test, an accurate higher yield for CE in patients with established, but not suspected, CD.
diagnosis and appropriate classification of IBD can often be challenging. However, a more recent updated meta-analysis suggests that, at least
Diagnosing small bowel (SB) involvement has been particularly compared with SBFT, CE may also be significantly better for the diagnosis of
challenging in the past due to a lack of adequate endoscopic and suspected CD.
7
radiologic modalities to evaluate the entire SB. Endoscopy remains the
cornerstone in the evaluation of IBD, with the diagnosis usually Multiple prospective studies have compared the diagnostic yield of CE with
established by a combination of clinical symptoms, laboratory markers, other endoscopic and radiologic techniques in patients with suspected CD.
and endoscopic and radiologic features. This review describes the new The yield of CE in these patients has been reported to range from 9 to 77%
imaging techniques available for the diagnosis of IBD. compared with a 0–23% yield with SBFT.
8–12
The yield of CE (28–58%) has
been found to be comparable to and may be even slightly higher than that
Endoscopy of ileoscopy (21–53%).
8,10,12,13
Two studies that have compared CE with PE
have shown a higher yield with CE (9–28% versus 0–10%, respectively)
10,11
Capsule Endoscopy and, similarly, two additional studies have shown a higher yield of CE
Capsule endoscopy (CE) was first introduced in 2001 (Pillcam SB, Given compared with CTE (37.5–77% versus 20–25%, respectively).
9,12
Imaging, Yoqneam, Israel), and is approved for use by the US Food and Drug
Administration (FDA) in both pediatric patients (older than 10 years) and
Shabana F Pasha, MD, completed her fellowship in
adults.
1
CE has the major advantage over other conventional endoscopic
gastroenterology and hepatology at the Mayo Clinic College of
modalities of allowing visualization of the entire SB in a non-invasive Medicine, Scottsdale, Arizona, and joins the faculty in the
manner.
2
Its main feature is the ability to evaluate patients with suspected
Division of Gastroenterology at that institution in November
2007. Prior to that, she completed her residency training in
SB disease, particularly obscure gastrointestinal bleeding and CD. It may also
internal medicine at the Mayo Clinic College of Medicine,
play a role in the evaluation of celiac disease, the surveillance of polyposis Rochester, Minnesota. Dr Pasha is a member of the American
syndromes, and occasionally, the evaluation of abdominal pain or diarrhea.
3 College of Gastroenterology, the American Gastroenterological
Association, and the American Society for Gastrointestinal
Endoscopy. She is board-certified in internal medicine and will be board-certified in
Up to 70% of patients with CD have SB involvement, with isolated gastroenterology in 2007. Her clinical and research interests include inflammatory bowel disease,
involvement of the SB in up to 30%, most commonly affecting the distal
colorectal cancer, small bowel diseases, including obscure gastrointestinal bleeding, and new
endoscopic modalities, including double-balloon enteroscopy and mucosal imaging techniques.
ileum.
4
These areas of SB involvement may not always be amenable to
evaluation by traditional endoscopic modalities because push enteroscopy
E:
pasha.shabana@mayo.edu
(PE) and ileoscopy allow only limited visualization of the proximal and distal Jonathan A Leighton, MD, is Professor of Medicine and Chair of
SB, respectively.
5
CE plays an important role in facilitating an evaluation of
the Division of Gastroenterology and Hepatology at the Mayo
Clinic College of Medicine, Scottsdale, Arizona. Dr Leighton is
the remainder of the SB, thereby allowing the diagnosis of CD that may be
also the Clinical Director of the Crohn’s and Colitis Clinic. He is
missed on conventional endoscopy. In addition, it allows an accurate an active member of the Crohn’s and Colitis Foundation of
assessment of the true extent of SB involvement.
America, the American Gastroenterology Society, and the
American Society of Gastrointestinal Endoscopy. He is also a
member of the American College of Gastroenterology and
CE has been shown to be superior to other diagnostic modalities in serves on the Educational Affairs Committee for that
evaluating patients with established CD. A meta-analysis of 11 studies
organization. Dr Leighton’s research interests include inflammatory bowel disease and small bowel
imaging techniques, including capsule endoscopy and double-balloon enteroscopy.
comparing CE with other diagnostic techniques—ileoscopy, physical
examination (PE), SB follow-through (SBFT), enteroclysis, computed
© TOUCH BRIEFINGS 2007
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