New methods enhance imaging of inflammatory bowel disease

The diagnosis and treatment of inflammatory bowel diseases — especially ulcerative colitis and Crohn’s — rely upon imaging techniques such as colonoscopy or ileal intubation. Traditional imaging methods, however, are not uniformly capable of determining the presence or extent of the diseases and are predominantly invasive. A colonoscopy, for example, provokes patient discomfort and can be unenlightening because of technical difficulties and poor preparation of the bowels.

According to Dr. Charles N. Bernstein and Dr. Barbara A. MacKalski of the University of Manitoba in Winnipeg, several emerging imaging technologies offer advantages in the diagnosis, follow-up and management of both Crohn’s disease and ulcerative colitis. In a review of these novel tools, the authors note that conventional imaging remains the primary means to patient care, but that equipment and techniques developed over the past five years are worthwhile complements to methods such as colonoscopy and small bowel x-ray.

They describe and discuss the advantages and disadvantages of wireless capsule endoscopy. They also discuss the attributes of MRI and MRI colonography, computed tomography enteroclysis, double-balloon enteroscopy, and transabdominal and endoscopic ultrasound. The authors conclude that wireless endoscopy, albeit too expensive for initial diagnosis or multiple uses per patient, is valuable for establishing Crohn’s disease when it is suspected and conventional studies are negative or impossible to conduct. (Gut, May 2006, pp. 733-741.)