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Establishing the diagnosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Investigations to establish the diagnosis of suspected Crohn's disease include:

  • colonoscopy with multiple biopsy specimens is used as the first line procedure to establish the diagnosis (1): assessment of strictures, colonic polyps, allow biopsy of terminal ileum, or multiple biopsies if a barium enema was equivocal
  • sigmoidoscopy and rectal biopsy
  • small bowel radiology: indicated if there are symptoms suggestive of small bowel involvement - diarrhoea, pain and weight loss. Crohn's colitis should be excluded by a subsequent barium enema.
  • barium enema: this is often more readily available than a colonoscopy. If positive, then small bowel radiology may be indicated to exclude other disease sites.
  • blood:
    • anaemia is common - generally iron deficiency anaemia, rarely B12 or folate deficiency
    • ESR and platelet count are usually raised, albumin is usually lowered
  • stool examination: Cl difficile toxin assay, pathogens
  • biopsy: granulomata are characteristic
  • laparotomy: often necessary to distinguish a Crohn's stricture from other causes of strictures, e.g. malignancy. Particularly relevant to the ileal form.
  • small bowel capsule endoscopy (SBCE) –
    • used in patients with negative ileocolonoscopy and radiological examinations but with a high degree of clinical suspicion of Crohn’s disease
    • sensitive in detecting small bowel mucosal abnormalities
    • contraindications are - gastrointestinal obstruction, strictures or fistulas, implanted electromedical devices (pacemakers) and swallowing disorders (1)

Reference:


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