Clin Endosc.  2016 Jul;49(4):370-375. 10.5946/ce.2016.090.

Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease

• Lee JM
• Lee KM

• KMID: 2348257
• DOI: http://doi.org/10.5946/ce.2016.090

Abstract

Patients with inflammatory bowel disease have significantly increased in recent decades in Korea. Intestinal tuberculosis (ITB) and intestinal Behcet's disease (BD), which should be differentiated from Crohn's disease (CD), are more frequent in Korea than in the West. Thus, the accurate diagnosis of these inflammatory diseases is problematic in Korea and clinicians should fully understand their clinical and endoscopic characteristics. Ulcerative colitis mostly presents with rectal inflammation and continuous lesions, while CD presents with discontinuous inflammatory lesions and frequently involves the ileocecal area. Involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps are more frequently seen in ITB than in CD. A few ulcers with discrete margins are a typical endoscopic finding of intestinal BD. However, the differential diagnosis is difficult in many clinical situations because typical endoscopic findings are not always observed. Therefore, clinicians should also consider symptoms and laboratory, pathological, and radiological findings, in addition to endoscopic findings.

Keyword

Inflammatory bowel diseases; Colitis, ulcerative; Crohn disease; Endoscopy; Diagnosis, differential

MeSH Terms

Cicatrix
Colitis, Ulcerative
Crohn Disease
Diagnosis*
Diagnosis, Differential
Endoscopy
Humans
Ileocecal Valve
Inflammation
Inflammatory Bowel Diseases*
Korea
Tuberculosis
Ulcer

Figure

• 

  Fig. 1. Typical endoscopic features of ulcerative colitis. (A) Mild: mucosal erythema, fine granularity, decreased vascular marking. (B) Moderate: marked erythema, loss of vascular marking, erosions. (C) Severe: ulcers. (D) Severe: spontaneous bleeding. (E) Luminal narrowing with pseudopolyps.

• 

  Fig. 2. Typical endoscopic features of Crohn’s disease. (A) Longitudinal ulcers, (B) cobblestone appearance, (C) aphthous ulcers showing longitudinal array.

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  Fig. 3. Typical endoscopic features of intestinal tuberculosis. (A) Transverse ulcers, (B) deformed and patulous ileocecal valve, (C) pseudopolyps.

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  Fig. 4. Typical endoscopic feature of intestinal Behcet’s disease. A large, round, deep, and discrete ulcer in the terminal ileum.

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