Assessment and Investigation of Inflammatory Bowel Disease

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Assessment and Investigation of Inflammatory
Bowel Disease

• Dr Ian Wilson
• Wakefield Gastroenterology Centre
• Wellington

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Classification of IBD
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Risk Factors

• Age
• Family history
• Smoking

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How to diagnose IBD
Typical symptoms Abnormal blood tests
Atypical symptoms Abnormal blood tests
Typical symptoms Normal blood tests
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Ulcerative colitis
Diarrhoea Often blood Mucous Abdominal
pain Urgency Incontinence Nocturnal
diarrhoea Extra colonic
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Crohns Disease

• Similar to UC
• plus
• Anal disease
• SI disease
• malabsorption
• Fistula
• Strictures

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Role of imaging

• Establish the diagnosis
• Distinguish UC from CD
• Stage the disease
• Assess disease activity
• Establish extent of disease
• Cancer surveillence

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Tools to investigate IBD

• Sigmoidoscopy

• Endoscopy
• Colonoscopy
• Gastroscopy
• ERCP
• Enteroscopy

• Wireless capsule endoscopy

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Tools to investigate IBD

• Radiology
• Barium studies
• CT scanning
• CT colonoscopy
• MRI scanning
• Nuclear Medicine

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Tools to investigate IBD

• Histology

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Endoscopic Assessment
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Colonoscopy
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CT colonoscopy
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CT colonoscopy

• Advantages
• less invasive and safer with no perforation or
  sedation risks
• no sedation needed
• substantially lower cost
• offers complete colonic exam in patients with
  tortuosity or tumor that may prevent passage of a
  colonoscope
• can assess colonic wall thickness and structures
  outside the colonic lumen 
• Disadvantages
• not entirely noninvasive - requires rectal tube
  and insufflation
• same cleansing prep as for colonoscopy
• inability to perform biopsy of suspicious
  findings at time of exam may require additional
  follow-up conventional colonoscopy
• less sensitivity for detection of very small
  polyps and superficial mucosal abnormalities than
  with colonoscopy
• Radiation exposure

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MR Colography
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Comparison
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Comparison
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The small intestine
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Small Intestine
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Wireless capsule endoscopy
Optical dome Lens holder Lens Illuminating LEDs
(light emitting diodes) CMOS (Complementary
Metal Oxide Semiconductor) image Battery ASIC
(Application Specific Integrated Circuit)
transmitter Antenna Dimensions Height 11mm
Width 26mm Weight 3.7gr
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GE Junction
Duodenum
Jejunum
Ileocecal Valve
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Phlebectasia
AVM
Lymphangectasia
Bleeding Lesion
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Lymphoma
GIST
Polypoid Mass
Polyp
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NSAID stricture
Radiation Enteritis
Sprue
Villous Drop Out
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Indications

• Obscure gastrointestinal bleeding
• Evaluation of extent of small intestinal
  disorders such as Crohns disease or Coeliac
  Disease
• Abnormal small intestinal imaging
• Suspected malabsorption
• Surveillance of polyposis syndromes involving
  small intestine

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Subtle Findings

• White tipped villi - a sign of inflammatory or
  infiltrative change
• Q-tip lesion

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Ileitis
Inflammatory polyp
Crohns disease
Linear Erosions
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Why Perform Wireless Capsule Endoscopy for IBD?

• Diagnosis
• Differentiate UC from Crohns disease
• Different natural history
• Different medical and surgical therapies
• Evaluate extent of small intestinal involvement
• Determine disease activity

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The future

• Chromo endoscopy
• MR colography and enterography
• Intestinal permeability calprotectin
• NON INVASIVE