A Comprehensive Multidisciplinary Approach to Diagnosing Chronic Inflammatory Bowel Diseases: Integration of Clinical, Endoscopic, and Imaging Modalities
Abstract
:1. Introduction
2. Clinical Approach
Biomarkers
3. Endoscopy
4. Histological Diagnosis
4.1. Crypt Architectural
4.2. Lamina Propria Cellularity: Chronic and Acute Inflammation and Epithelioid Cell Granuloma
4.3. Epithelial Abnormalities
5. New Advance Endoscopic Techniques
6. Wireless Video Capsule Endoscopy and Enteroscopy
7. Advanced Imaging Techniques
8. Future Directions—Pre-Clinical Diagnosis of Inflammatory Bowel Disease
9. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Tools for Diagnosis of IBD | |
---|---|
Clinical evaluation | Evaluate presence of gastrointestinal symptomsa and Extra intestinal symptoms; family history of IBD; autoimmune disease |
Laboratory tests | Stool examinations for enteric infections; fecal calprotectin and lactoferrin test; laboratory tests such as C-reactive protein, blood cell count, iron, and vitamins |
Endoscopy | Ileocolonscopy with biopsies: in all patients with suspected IBD; Esophagogastroduodenoscopy with biopsies: if upper symptoms; VCE: if suspected CD and negative findings on ileocolonoscopy; DAE: to take biopsies or when stenosis is expected; CLE: for inflammation assessment |
Imaging techniques | IUS, MRE, or CTE to evaluate the extent of small bowel involvement in CD, disease activity, and complications; IUS and CTE to evaluate the extent of disease and complications in ulcerative colitis |
Partial Mayo Score [Index] | 0 | 1 | 2 | 3 |
---|---|---|---|---|
Stool frequency | Normal | 1–2/day > normal | 3–4/day > normal | 5/day > normal |
Rectal bleeding | None | Streaks | Obvious | Mostly blood |
Physician’s global assessment | Normal | Mild | Moderate | Severe |
Variable | Variable Description |
---|---|
General well-being | 0 = very well; 1 = slightly below average; 2 = poor; 3 = very poor; 4 = terrible |
Abdominal pain | 0 = none; 1 = mild; 2 = moderate; 3 = severe |
Number of liquid stools | 0 = 0–1 stools; 1 = 2–3 stools; 2 = 4–5 stools; 3 = 6–7 stools; 4 = 8–9 stools; 5 = 10+ stools |
Abdominal mass | 0 = none; 1 = dubious; 2 = definite; 3 = tender |
Complications | None, uveitis, arthalgia, erythema nodosum, aphthous gangrenosum, anal fissure, new fistula, abscess; one point each |
Variable | 0 | 1 | 2 | 3 |
---|---|---|---|---|
Size of ulcers | None | Afthous ulcers (Diameter 0.1 to 0.5 cm) | Large ulcers (Diameter 0.5 to 2 cm) | Very large ulcers (Diameter > 2 cm) |
Ulcerated surface | None | <10% | 10–30% | >30% |
Affected surface | Unaffected segment | <50% | 50–75% | >75% |
Presence of narrowings | None | Single, can be passed | Multiple, can be passed | Cannot be passed |
Mayo Endoscopic Score | Endoscopic Features |
---|---|
0 | None |
1 | Erythema, decreased vascular pattern, mild friability |
2 | Marked erythema, absent vascular pattern, friability, erosions |
3 | Spontaneous bleeding, ulcerations |
Typical Histological Features | Ulceratis Colitis | Crohn’s Disease | Infectious Colitis |
---|---|---|---|
Lymphoid aggregates | Frequent in mucosa | Common, transmural | Present in mucosa |
Granulomas | Absent | Common, transmural | Possible in tubercolosis enteritis |
Localization of inflammation | Limited to the mucosa | Transmural | Limited to the mucosa |
Active inflammation | Diffuse | Focal with skip lesions | Diffuse |
Cryptitis, crypt abscesses | Diffuse continuous | Focal discontinuous | Frequent, diffuse |
Crypt architectural distortion | Diffuse | Focal, frequent | Usually absent |
Atrophy | Present | Uncommon, mild | Rare |
Pyloric metaplasia | Rare | Present | Rare except in tuberculosis enteritis |
Basal plasmacytosis | Present | Present | Usually absent |
Radiological Imaging Techniques in Inflammatory Bowel Disease | Advantages of Radiological Imaging Techniques in IBD | Disadvantages of Radiological Imaging Techniques in IBD |
---|---|---|
Magnetic resonance enterography | Non-invasive nature Assessment of disease extent and severity Evaluation of disease complications Sensitivity > 97% | Radiation exposure Contrast agent administration High cost Contraindicated in patients with certain medical devices or claustrophobia Diagnostic accuracy for stenosis is based on the use of luminal contrast |
Intestinal ultrasound | Non-invasive nature Assessment of disease extent and severity Cost-effective No oral preparation Easily reproducible Evaluation of disease complications Sensitivity > 92% | Operator dependence Poor image quality in patients with excess abdominal weight |
Computed tomography enterography | Non-invasive nature Assessment of disease extent and severity Evaluation of disease complications Sensitivity > 84% | Radiation exposure Contrast agent administration High cost |
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Cicerone, C.; D’Amico, F.; Allocca, M.; Zilli, A.; Parigi, T.L.; Danese, S.; Furfaro, F. A Comprehensive Multidisciplinary Approach to Diagnosing Chronic Inflammatory Bowel Diseases: Integration of Clinical, Endoscopic, and Imaging Modalities. Diagnostics 2024, 14, 1530. https://doi.org/10.3390/diagnostics14141530
Cicerone C, D’Amico F, Allocca M, Zilli A, Parigi TL, Danese S, Furfaro F. A Comprehensive Multidisciplinary Approach to Diagnosing Chronic Inflammatory Bowel Diseases: Integration of Clinical, Endoscopic, and Imaging Modalities. Diagnostics. 2024; 14(14):1530. https://doi.org/10.3390/diagnostics14141530
Chicago/Turabian StyleCicerone, Clelia, Ferdinando D’Amico, Mariangela Allocca, Alessandra Zilli, Tommaso Lorenzo Parigi, Silvio Danese, and Federica Furfaro. 2024. "A Comprehensive Multidisciplinary Approach to Diagnosing Chronic Inflammatory Bowel Diseases: Integration of Clinical, Endoscopic, and Imaging Modalities" Diagnostics 14, no. 14: 1530. https://doi.org/10.3390/diagnostics14141530
APA StyleCicerone, C., D’Amico, F., Allocca, M., Zilli, A., Parigi, T. L., Danese, S., & Furfaro, F. (2024). A Comprehensive Multidisciplinary Approach to Diagnosing Chronic Inflammatory Bowel Diseases: Integration of Clinical, Endoscopic, and Imaging Modalities. Diagnostics, 14(14), 1530. https://doi.org/10.3390/diagnostics14141530