Fast Five Quiz: Diagnosis of Crohn Disease

Jaime Shalkow, MD


January 12, 2022

Video capsule endoscopy is complementary in the diagnosis of patients with small-bowel Crohn disease owing to its inability to collect tissue samples. However, it provides an alternative method for visualizing the small-bowel mucosa without radiation exposure and may detect suggestive lesions that are not visible by other small-bowel studies.

Upper endoscopy, or esophagogastroduodenoscopy, should only be performed in patients with upper GI signs and symptoms. However, patients with Crohn disease who have upper GI involvement are often asymptomatic at the time of diagnosis. Endoscopic features that would suggest a diagnosis of Crohn disease are mucosal nodularity, ulceration (both aphthous and linear), antral thickening, and duodenal strictures. Imaging modalities, such as CT and MRI, may offer diagnostic value in identifying upper GI complications (eg, stricturing) and are less invasive than endoscopy.

MRI with enterography has a sensitivity that is similar to CT enterography, which is up to 90%, for detecting inflammation associated with Crohn disease. These features include bowel wall enhancement (hyperintensity possibly reflecting edema), increased wall thickness, and mucosal lesions.

Learn more about Crohn disease workup.

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