Endoscopic evaluation in diagnosis and management of inflammatory bowel disease

Table 1 Mimics of active inflammatory bowel disease

Condition	Comment	Ref.
ITB	Skip lesions, cobblestoning of mucosa, apthous and linear ulcers are found more frequently in patients with CD compared to ITB	[8,9]
	Patulous ileocaecal valve, transverse ulcers more common in ITB	[9,10]
Segmental colitis associated with diverticulosis	Inflammatory changes limited to the segment of bowel containing the diverticula with rectal sparing	[11]
CMV colitis superimposed in IBD	Mucosal bleeding on light contact, wide mucosal defects and punched out ulcers more common in UC complicated by CMV	[12]
	The presence of ulcers helps predict CMV in patients with UC but not CD	[13]
	Other studies could not identify striking differences on endoscopy	[14]
	Biopsies of inflamed mucosa needed assess for inclusion bodies characteristic for CMV colitis
Clostridium difficle associated disease	Pseudomembranes seldom occur in patients with IBD and Clostridium difficile infection	[15]
Campylobacter colitis	Can produce similar appearences to that of UC, detailed endoscopic assessment can help discern from IBD, in addition to stool cultures and biopsies	[16,17]
Ischaemic colitis	Typically a segmental disease, with normal mucosa proximal and distal to affected region of colon	[18]
	Rectum usually spared	[19]
Medication effects	Endoscopic assessment of Ipilimumab induced colitis reveals absent vascular pattern, and erythema in most patients. Variety of endoscopic features described in recent retrospective study	[20]
	NSAID induced colopathy can affect the whole colon, but has a right sided predominance. Colonic findings include ulceration, strictures and diaphragm like strictures	[21]
Solitary rectal ulcer syndrome	Ulcerative lesions (either single or multiple) most common finding, however can present with erythema or polypoid lesions	[22]
Behçet disease	Predilection for ulcers in the ileo-caecal region. Ulcers are typically larger than 1 cm, deep and have discrete margins	[23]
Amebic colitis	Endoscopic findings can vary from procto-sigmoiditis to right colonic involvement, biopsy and microscopic identification of Entamoeba species useful in evaluation of suspected amebiasis	[24]

IBD: Inflammatory bowel disease; ITB: Intestinal tuberculosis; CMV: Cytomegalovirus; CD: Crohn’s disease; NSAID: Non-steroidal anti-inflammatory drug.