New diagnostic imaging tools for inflammatory bowel disease

TL;DR: Conventional investigations in patients with suspected or proven inflammatory bowel disease include colonoscopy, ileal intubation, and small bowel follow through (SBFT) or small bowel enteroclysis (SBE); it is recognised that these diagnostic modalities may not be uniformly confirmatory.

Abstract: The diagnosis of Crohn’s disease is established through an assessment of the clinical presentation with confirmatory evidence from radiographic, endoscopic, and pathological findings. As there is no known cure, and the condition runs a relapsing course, patients are recurrently reinvestigated. Although ultimately curable by colectomy, many patients with ulcerative colitis (UC) are managed medically for years, and require investigations to define the extent of disease, to re-examine diagnosis validity as clinical findings change, and to facilitate dysplasia surveillance. Imaging studies in these diseases serve to establish the primary diagnosis and to provide information for guiding the management of patients with known disease.1 Conventional investigations in patients with suspected or proven inflammatory bowel disease include colonoscopy, ileal intubation, and small bowel follow through (SBFT) or small bowel enteroclysis (SBE). It is recognised that these diagnostic modalities may not be uniformly confirmatory. Complete colonoscopy is not always possible due to technical difficulties, poor preparation, or patient intolerance. While the rate of ileal intubation by experienced endoscopists is reported to be 74%, that rate exceeds 90% when intubation is deemed necessary.2 A recent study reports that the rate of ileal intubation is low in the presence of an endoscopically normal colon, even when symptoms suggestive of inflammatory bowel disease are present.3 Of the 20 638 patients who underwent colonoscopy in the setting of an endoscopically normal colon for the indication of abdominal pain, diarrhoea, or anaemia, ileal intubation was performed only 18% of the time. SBFT is considered a reliable approach to imaging the small bowel in inflammatory bowel disease, provided that it is a dedicated study, incorporating fluoroscopy with manual manipulation.4 The sensitivity and specificity of SBFT in terminal ileal disease is reported in the range of 85–95% and 89–94%, respectively, but these parameters are highly dependent on …