Diagnostics of Inflammatory Bowel Disease

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Diagnostics of Inflammatory Bowel Disease Susanna Nikolaus, Stefan Schreiber Gastroenterology Volume 133, Issue 5, Pages 1670-1689 (November 2007) DOI: 10.1053/j.gastro.2007.09.001 Copyright © 2007 AGA Institute Terms and Conditions

Figure 1 Typical endoscopic findings in UC and CD. (A–C) UC. (A) UC with mild inflammation and reduced haustration, vascular transparency is missing. (B) Moderate inflammation with reduced haustration. The mucosa is edematous, covered with fibrin, and shows multiple erosions. (C) Severe inflammation with inflammatory narrowing of the lumen through pseudopolyps. (D–F) CD. (D) Mild inflammation with an isolated small aphthous mucosal lesion. (E) Moderate inflammation with some flat longitudinal ulcers. (F) Severe inflammation with deep snail track ulcers. (G–H) Chronic mucosal lesions without active inflammation. (G) Distinct formations of scars in patients with UC. The corresponding abdominal flat film (barium enema) shows a rigid colon with no haustration. (H) Chronic, fibrotic stenosis of the terminal ileum in a patient with CD. (I) Chronic destruction of the ileocecal valve in CD. Gastroenterology 2007 133, 1670-1689DOI: (10.1053/j.gastro.2007.09.001) Copyright © 2007 AGA Institute Terms and Conditions

Figure 2 Microscopic findings in biopsies from patients with CD and UC (hematoxylin and eosin staining). (A–C) Granuloma in a patient with CD. (D, E) Crypt abscess in UC. (F) Pseudopolyp formation. L, lymph follicle. Gastroenterology 2007 133, 1670-1689DOI: (10.1053/j.gastro.2007.09.001) Copyright © 2007 AGA Institute Terms and Conditions

Figure 3 (A, B) Plain abdominal radiographs of patients with IBD presenting with acute abdominal pain. (A) Extremely dilated colon in severely acute UC. (B) Small bowel ileus in a patient with CD that shows typical fluid levels. The patients had an ileal fibrotic stenosis. (C–E) Small bowel follow-through in a patient with a long, fibrotic stenosis in the terminal ileum. Excretion of the contrast agents was extensively prolonged. (C) Radiograph taken after day 1. (D) Day 2. (E) Day 3. Gastroenterology 2007 133, 1670-1689DOI: (10.1053/j.gastro.2007.09.001) Copyright © 2007 AGA Institute Terms and Conditions

Figure 4 Sonography of the bowel in conventional and power Doppler modes. (A) Patient with acute UC (pancolitis). Continuous thickening of the bowel wall up to 3 mm. Preserved lamination of the bowel wall, accentuated submucosa, and irregular mucosal border. (B) Increased perfusion of the bowel wall in the power Doppler mode. (C, D) CD patient with thickening of the intestinal wall of the terminal ileum (up to 7 mm) with relative stenosis. Within the region showing the most prominent wall thickening, 4 fistula tracts are found that connect with the sigmoid colon. Gastroenterology 2007 133, 1670-1689DOI: (10.1053/j.gastro.2007.09.001) Copyright © 2007 AGA Institute Terms and Conditions

Figure 5 Pelvic MRI in a patient with CD with a pelvine, presacral abscess. (A) Sagittal, T1-weighted image. A, abscess; F, fistula. (B) Same patient; T2-weighted image. (C) Same patient, intraoperative situs. Arrows, fistula. Gastroenterology 2007 133, 1670-1689DOI: (10.1053/j.gastro.2007.09.001) Copyright © 2007 AGA Institute Terms and Conditions

Figure 6 Rectal endosonography in a CD patient with an intersphincteric abscess. 1, probe; 2, dilatated balloon; 3, musculus sphincter internus; 4, musculus sphincter externus; 5, intersphincteric abscess. Gastroenterology 2007 133, 1670-1689DOI: (10.1053/j.gastro.2007.09.001) Copyright © 2007 AGA Institute Terms and Conditions