Crohn's Disease (cont.)
How is Crohn's disease diagnosed?
The diagnosis of Crohn's disease is suspected in patients with fever,
abdominal pain and tenderness, diarrhea with or without bleeding, and anal
diseases. Laboratory blood tests may show elevated white cell counts and
sedimentation rates, both of which suggest infection or inflammation. Other
blood tests may show low red blood cell counts (anemia), low blood proteins, and
low body minerals, reflecting loss of these elements due to chronic diarrhea.
Barium x-ray studies can be used to define the distribution, nature, and
severity of the disease. Barium is a chalky material that is visible by x-ray
and appears white on x-ray films. When barium is ingested orally (upper GI
series) it fills the
intestine and pictures (x-rays) can be taken of the stomach and the small
intestines. When barium is administered through the rectum (barium
enema), pictures of the
colon and the terminal ileum can be obtained. Barium x-rays can show
ulcerations, narrowing, and, sometimes, fistulae of the bowel.
Direct visualization of the rectum and the large intestine can be
accomplished with flexible viewing tubes (colonoscopes). Colonoscopy is more
accurate than barium x-rays in detecting small ulcers or small areas of
inflammation of the colon and terminal ileum. Colonoscopy also allows for small
tissue samples (biopsies) to be taken and sent for examination under the
microscope to confirm the diagnosis of Crohn's disease. Colonoscopy also is more
accurate than barium x-rays in assessing the degree (activity) of inflammation.
Computerized axial tomography (CAT or CT) scanning is a computerized x-ray
technique that allows imaging of the entire abdomen and pelvis. It can be
especially helpful in detecting abscesses.
Most recently, video capsule endoscopy has been added to the list of
diagnostic tests for diagnosing Crohn's disease. For video capsule
endoscopy, a capsule containing a miniature video camera is swallowed. As
the capsule travels through the small intestine, it sends video images of the
lining of the small intestine to a receiver carried on a belt at the
waist. The images are downloaded and then reviewed on a computer.
The value of video capsule endoscopy is that it can identify the early,
mild abnormalities of Crohn's disease. Video capsule endoscopy may be
particularly useful when there is a strong suspicion of Crohn's disease but the
barium x-rays are normal. (Barium x-rays are not as good at identifying early,
mild Crohn's disease.)
Video
capsule endoscopy should not be performed in patients who have obstruction of
the small intestine. The capsule may get stuck behind the obstruction and make
the obstruction worse. Doctors usually also are reluctant to perform
video-capsule endoscopy for the same reason in patients who they suspect of
having small intestinal strictures (narrowed segments of small intestine that
can result from prior surgery, prior radiation, or chronic ulceration, for
example, from Crohn's disease). There is also a
theoretical concern for electrical interference between the capsule and
implanted cardiac pacemakers and
defibrillators; however, so far in a small
number of patients with pacemakers or defibrillators who have undergone video
capsule endoscopy there have been no problems.
Next: How is Crohn's disease treated? »
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