Diagnosing a patient with inflammatory bowel disease like Crohn’s disease (CD) or ulcerative colitis (UC) is a process that involves multiple steps.1 If the results of physical examination, blood tests, and stool tests suggest that a person’s symptoms are being caused by inflammation in the digestive tract, then the primary care physician may refer the patient to a gastroenterologist. Gastroenterologists are physicians who specialize in the health of the digestive system; they are specially trained to perform a special type of diagnostic procedure called endoscopy.
Endoscopy procedures allow the gastroenterologist to look inside a person’s digestive tract using a special instrument called an “endoscope.” An endoscope is a long, thin tube with a very small camera and light attached to the end of it, which projects images of the digestive tract onto a screen for evaluation.
What are biopsies?
During some types of endoscopy procedures, the gastroenterologist uses the endoscope to collect small samples of tissue from inside the digestive tract, which are called “biopsies.”1 Biopsies can then be analyzed in the laboratory to provide further information to aid in diagnosis of inflammatory bowel disease (IBD).
What types of endoscopy procedures are typically used to help diagnose inflammatory bowel disease?
A type of endoscopy called a “colonoscopy” is the most common type performed to help diagnose a person with IBD.1 Other types include:
- Upper endoscopy
- Capsule endoscopy
- Balloon endoscopy
- Flexible sigmoidoscopy
What is a colonoscopy?
A colonoscopy is a procedure used to assess the health of the colon and the end of the small intestine, which are the areas that are most often affected by IBD.1 The gastroenterologist will check if there is inflammation inside the digestive tract, and assess its location and severity.
During a colonoscopy, a colonoscope, a four-foot-long tube approximately 1/2-inch-thick with a camera at its tip, is inserted into the patient’s rectum. A light at the tip of the colonoscope allows the gastroenterologist to move the instrument slowly through the length of the colon and the end of the terminal ileum (small bowel). This type of procedure is especially helpful in diagnosing CD related to inflammation occurring at the junction of the ileum and the colon. UC may occasionally cause inflammation in the ileum, but it is generally mild.2
Healthcare providers will give patients specific instructions about how to prepare for the colonoscopy. This usually involves emptying the bowels of all fecal matter the night before the procedure, so that the gastroenterologist can have a clear view of the inside of the digestive tract. Patients are usually sedated prior to the colonoscopy and remain sedated throughout the procedure.
What is an upper endoscopy?
Some patients have symptoms linked to CD, but a colonoscopy does not show signs of inflammation.1,3 In those cases, gastroenterologists may recommend having an upper endoscopy (also called an EGD). This type of procedure is also used if a patient is experiencing symptoms in the upper part of the gastrointestinal tract that can be caused by CD, such as:
- Chronic heartburn
- Regurgitating food
- Pain in the upper abdomen
- Difficulty swallowing
- Persistent nausea
- Weight loss
An EGD is a procedure commonly used to examine the lining of your esophagus, or the muscular tube that connects your throat to the upper part or your small intestine. An EGD is administered by inserting a thin tube with a small camera at the tip into the patient’s throat. The endoscope is then moved down along the length of the esophagus, giving the gastroenterologist a useful visual of the esophageal lining. Small tissue samples (biopsies) of the patient’s esophagus may be taken to analyze for signs of inflammation caused by CD.4
What is a capsule endoscopy?
Capsule endoscopy is a relatively new procedure that allows examination of a large portion of the small intestine that cannot be viewed by colonoscopy or upper endoscopy.1,3 At the beginning of the procedure, the patient swallows a capsule containing a tiny video camera, about the size of a large pill. The camera then moves through the patient’s small intestine, sending approximately 60,000 pictures of the inside of the small intestine to an external receiver, usually worn on the outside of the abdomen. During the procedure the patient can carry out their usual activities, and the capsule is eventually excreted in the stool. A healthcare provider then reviews the images, which can be especially useful in identifying earlier, milder signs of CD.1,5
The procedure is not recommended for patients with an obstruction of the small intestine, as there is risk of the capsule getting stuck. Patients with implanted electrical devices, such as pacemakers and defibrillators, should consider other options for diagnosis as well.
What is balloon endoscopy?
Balloon endoscopy, also called balloon enteroscopy, is a procedure used to examine and take small tissue samples of a patient’s small intestine to aid in the diagnosis of CD.6 There are two types of balloon endoscopy: single balloon and double balloon.
A balloon endoscopy also uses a small flexible tube with a lighted camera at the tip. During a single balloon endoscopy, a balloon is attached to an overtube inserted over the endoscope. The balloon, which can be inflated or deflated, can be used to anchor the overtube in the intestine when it is inflated and allow the endoscope to move further into the small intestine. In other words, the balloon helps to manipulate the small intestine to allow the endoscope to move through the digestive tract more easily.6
A double balloon endoscopy involves a balloon not only over the overtube, but also at the tip of the endoscope. Similarly to the single balloon procedure, the balloons are inflated and deflated to allow the endoscope to pass more easily through the small intestine.6
What is flexible sigmoidoscopy?
Flexible sigmoidoscopy is a procedure used to examine the rectum and the sigmoid colon.1,7 A sigmoidoscope, a long narrow tube with a light and a camera at the tip, is inserted into the patient’s rectum and travels through the sigmoid colon, which is the lower one-half to one-third of the colon. This type of procedure is useful in identifying inflammation from IBD, ulcers, cancerous growths and polyps, or extraneous tissue growth on the inner lining of the intestine.