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The Use of Endoscopy to Follow the Clinical Course of Crohn’s Disease

  • Mark A. SamaanEmail author
  • Geert D’Haens
Chapter
  • 1.3k Downloads

Abstract

In contrast to traditional aims in the treatment of Crohn’s disease, recent studies have identified mucosal healing as an important therapeutic goal. Conventional management focused predominantly on achieving clinical remission, without necessarily accomplishing response at a mucosal level. However, evidence has emerged demonstrating that achieving and maintaining mucosal healing can alter the natural history of the disease. Until recently this outcome seemed out of reach for treatment strategies designed only to ameliorate symptoms. This revelation gains pivotal importance when considered in conjunction with the advent of biological agents with the ability to effectively deliver this goal. In this chapter we will present the evidence, which gave rise to this critical change of paradigm. Despite this clear progress, there remain a number of unresolved issues regarding its implications for the monitoring and treatment of patients with Crohn’s disease. For instance, a universally accepted definition for mucosal healing has yet to be agreed. The same is true of the minimal clinically relevant change in endoscopic appearance. There are also practical issues regarding the integration of endoscopic goals into clinical treatment strategies. In this chapter we explore these issues in light of the latest evidence. The endoscopic indices used to objectively quantify disease activity in Crohn’s disease will also be described, along with their development, properties and practical use. Finally, we will make suggestions on how this understanding can be integrated into clinical practice to optimize the management of patients with Crohn’s disease.

Keywords

Crohn’s disease Endoscopy Mucosal healing Endoscopic remission Crohn’s Disease Endoscopic Index of Severity (CDEIS) Simple Endoscopic Score in Crohn’s Disease (SES-CD) Rutgeerts Crohn’s Disease Activity Index (CDAI) 

Supplementary material

Video 14.1

Active terminal ileal CD. (AVI 170,996 kb)

Video 14.2

Colonic CD. (MOV 333,282 kb)

Video 14.3

Example of Rutgeerts i1 recurrence of CD. (AVI 84,348 kb)

Video 14.4

Example of Rutgeerts i4 recurrence of CD. (AVI 178,761 kb)

Video 14.5

Improvement in terminal ileal CD appearance following infliximab. (AVI 189,275 kb)

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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Inflammatory Bowel Disease Centre, Academic Medical CentreAmsterdamThe Netherlands

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