Colonoscopy
This examination is performed to assess both the rectum and the large intestine along its entire length. In most cases, the examination also investigates the distal part of the small intestine. The procedure is conducted with deep sedation, and in children, it usually requires certified anesthesia. During the examination, the doctor inserts a flexible tube with a tiny camera through the anus to inspect for inflammation, locate its presence, and determine its severity. Patients with colitis for more than ten years should undergo colonoscopy every 1-3 years to detect pre-cancerous changes related to Crohn's disease, if present. Starting a day before the procedure, the patient should follow the doctor's instructions for bowel cleansing using various devices.
Sigmoidoscopy
Sigmoidoscopy is a similar test to colonoscopy but much shorter, focusing on examining the rectum and the distal part of the large intestine called the sigmoid colon. This shorter test is sufficient in cases where a general evaluation of disease severity is needed, such as for treatment assessment or when non-specific symptoms occur.
Gastroscopy
Gastroscopy is a test performed to examine the esophagus, stomach, and duodenum (the first part of the small intestine). During the procedure, a flexible tube is inserted through the mouth, and a tiny camera is passed through it to check for inflammatory involvement of the upper digestive tract, which may indicate conditions like Crohn's disease and guide treatment planning. In children, the examination is typically done under anesthesia and is routine for evaluating inflammatory bowel disease. In adults, it is usually performed only when specific symptoms are present.
Abdominal X-ray
Abdominal X-ray plays a minor role in diagnosing inflammatory bowel diseases, though there are hints in the X-ray images that can point to this diagnosis. Regular abdominal X-rays are important for assessing acute conditions related to Crohn's disease, such as bowel obstruction or toxic megacolon.
Barium Swallow
As a complement to the X-ray tests, this test uses a contrast material injected into the rectum to visualize the large intestine. Although it provides good imaging of the colon's thickness, endoscopic technologies now offer more precise views of the colon, including biopsies. With the advancement of endoscopic procedures, the role of this test has diminished.
CT Enterography (CTE)
This test creates a three-dimensional image of the body's organs using X-ray technology. The resolution has improved significantly in recent years, and with the use of contrast agents, it can provide better visualization of the intestine than a barium swallow. It's used as a supplement to diagnose and characterize the disease accurately. The radiation exposure is a drawback, but modern CT machines have reduced radiation levels.
Magnetic Resonance Enterography (MRE)
This specialized MRI test offers the same quality image as CTE without radiation exposure. It can also provide disease activity measurements without endoscopy. It's an excellent alternative to both barium swallow and CTE.
Capsule Endoscopy
This test allows imaging of the small intestine, which is not accessible through colonoscopy or gastroscopy. Patients above the age of ten swallow a capsule that transmits images to an external device while passing through the intestines. For younger children who can't swallow the capsule, it can be placed in the small intestine using a gastroscopy. The recorded images are reviewed like a video, allowing for the identification of inflamed areas or ulcers suspected of being related to Crohn's disease. The test is more accurate than a barium swallow and provides a non-invasive way to diagnose intestinal pathologies.
Ultrasound
Ultrasound technology has improved over time, offering better resolution for imaging the intestine's thickness, detecting inflammation, abscesses, and other rare complications. It's a simple, cost-effective, and non-radiating procedure. However, its accuracy depends on the operator's skill.
Other Tests
Additional tests, such as using marked white blood cells targeted to areas of inflammation, exist globally but are not commonly used in Israel. These tests provide additional information compared to the aforementioned tests but are less frequently employed.