Inflammatory Bowel Disease of the Small Bowel

Abstract

The advent of capsule endoscopy (CE) and device-assisted enteroscopy (DAE) has dramatically changed the diagnostic and therapeutic approach to known or suspected inflammatory bowel disease (IBD). Using CE, Crohn’s disease (CD) is diagnosed by finding more than three ulcerations in the absence of nonsteroidal anti-inflammatory drug (NSAID) use. Finding more than ten aphthae plus circumferential ulcerate stenosis on CE is strongly suggestive of CD. Minor findings include villous edema or denudation, erythema, erosions, and cobblestone appearance. Since there are presently no standardized endoscopic criteria for the diagnosis of CD using CE, it is difficult to differentiate other inflammatory diseases, such as NSAID-induced enteropathy or tuberculous enteritis. Although ulcerative colitis is generally regarded as predominantly involving the rectum and spreading proximally, gastroduodenal lesions, backwash ileitis, postcolectomy pouchitis, and diffuse enteritis following colectomy have also been reported. This chapter is focused on the endoscopic findings of IBD diagnosed using CE and DAE.