Investigating the Small-Bowel: A Brief and Concise Update – Pages 18-28
Anastasios Koulaouzidis1,* and John N. Plevris1,2
1Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Scotland, UK
2Medical School, The University of Edinburgh, Edinburgh, Scotland, UK
DOI: http://dx.doi.org/10.12970/2308-6483.2013.01.01.4
Download PDFAbstract: Investigation and endoscopic intervention options for small-bowel pathology in the second decade of the 21st century are extensive. As such, it is important that sensible and cost-effective diagnostic strategies are being applied. For example, in the investigation of probable IBS faecal calprotectin (FC) estimation is useful first line test. If Crohn’s disease is suspected, by a raised FC, colonoscopy with terminal ileal biopsies may confirm the diagnosis. If diagnostic doubts remain, a small-bowel capsule endoscopy is useful. In the presence or suspicion of a Crohn’s disease stricture, detailed characterization by magnetic resonance (MR) or computed tomography (CT) enteroclysis would be the first investigation of choice. Deep or device-assisted enteroscopy is indicated if biopsies are needed from areas deep in the small-bowel, such as in cases of unusual distribution of Crohn’s disease. In the case of obscure gastrointestinal bleeding (OGIB), bi-directional endoscopy (upper endoscopy and colonoscopy) remains the diagnostic cornerstone. If there is strong suspicion of bleeding from the small-bowel, SBCE followed by deep enteroscopy for therapy are indicated.
Keywords: Small bowel, capsule endoscopy, SmartPill, faecal calprotectin, 7a-cholestenone, hydrogen breath test, obscure gi bleeding, crohn’s disease, coeliac disease.
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