Fast Five Quiz: Diagnosis of Crohn Disease

Jaime Shalkow, MD

Disclosures

January 12, 2022

Ileocolonoscopy is typically the first-line approach in the workup of Crohn disease, and colonoscopy can appropriately assess mucosal involvement in more than 80% of patients with IBD.

During colonoscopy, biopsy samples are obtained from the right colon, left colon, and rectum, even if they are endoscopically normal in appearance, to assess for histologic evidence of inflammation. The histologic findings include focal (discontinuous) chronic inflammation, focal crypt irregularity (discontinuous crypt distortion), granulomas, and transmural lymphoid aggregates. These findings are usually confirmatory rather than diagnostic.

In terms of additional workup approaches, biopsies of uninvolved mucosa are recommended to measure the extent of histologic disease. Fecal calprotectin can help differentiate IBD from irritable bowel syndrome. Antiglycan antibodies are more prevalent in Crohn disease than in ulcerative colitis, but they are not sensitive.

Learn more about the workup of Crohn disease.

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