Inflammatory Bowel Disease

**27**

**Chapter 3**

**Abstract**

small bowel CD.

**1. Introduction**

repeated investigations.

classify disease phenotype and behavior.

Disease

Endoscopy in Small Bowel Crohn's

Crohn's disease (CD) is a complex disorder with variable age of onset, disease location and behavior. It is characterized by a transmural inflammation that may involve any portion of the gastrointestinal tract. Ileocolonoscopy with biopsy is established as the first-line investigation for suspected CD. However, small bowel involvement is more difficult to assess by conventional endoscopy. Therefore, radiological imaging should also be performed to complement ileocolonoscopy in all patients with suspected CD. Recently, video capsule endoscopy and deviceassisted enteroscopy have revolutionized the management of small bowel CD. In fact, video capsule endoscopy is a non-invasive test that provides the visualization of the entire small bowel mucosa, which can assist in the diagnosis of CD and assess the therapeutic response. On the other hand, device-assisted enteroscopy enables direct tissue sampling for histopathology confirmation when traditional endoscopy, video capsule endoscopy and cross-sectional imaging are inconclusive. Moreover, it allows therapeutic interventions such as balloon stricture dilation. In this chapter, we review the role of endoscopy in the diagnosis and management of patients with

**Keywords:** Inflammatory bowel disease, Crohn's disease, endoscopy, small bowel

Crohn's disease (CD) is an idiopathic inflammatory disorder with genetic, immunologic and environmental influences [1]. It is characterized by a transmural inflammation that may involve any portion of the luminal gastrointestinal tract, from the oral cavity to the perianal area. The diagnosis is based on the combination of clinical, biochemical, radiological, endoscopic and histological findings. CD is a chronic and progressive disease, marked by frequent relapses which usually require

The most common symptoms of CD are diarrhea, abdominal pain and fatigue. However, clinical manifestations can be very heterogeneous, depending on the disease location and phenotype. Patients with CD often show laboratory evidence of inflammatory activity and anemia. In addition, fecal calprotectin and serum C-reactive protein are useful markers to detect and monitor inflammation. The endoscopic hallmark of CD is the patchy distribution of inflammation and mucosal biopsies usually show focal inflammation (rather than diffuse), crypt distortion and/or granulomas. Finally, cross-sectional imaging techniques provide information about the bowel wall and extra-enteric soft tissues and, therefore, can better

*Isabel Garrido, Susana Lopes and Guilherme Macedo*
