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©2012 Baishideng Publishing Group Co.
World J Gastrointest Endosc. Jun 16, 2012; 4(6): 201-211
Published online Jun 16, 2012. doi: 10.4253/wjge.v4.i6.201
Published online Jun 16, 2012. doi: 10.4253/wjge.v4.i6.201
Table 1 Infective causes of inflammation which mimic inflammatory bowel disease
Infective cause | Endoscopic appearance |
Salmonella | Friable mucosa with haemorrhages in ileum and colon |
Shigella | Patchy intense erythema in ileum and colon |
Campylobacter | Erythema and ulcers in colon |
E.coli 0157:H7 | Mild to moderately severe colitis |
Yersinia | Patchy colitis with ileal aphthoid ulcers |
C.difficile | Pseudo membranes and predominantly left side colitis |
Klebsiella | Haemorrhagic colitis |
Mycobacterium | Transverse or circumferential ulcers ileum |
Neisseria | Proctitis with ulcers and peri anal disease |
Chlamydia | Peri anal abscess, ulcer and fistula |
Treponema | Proctitis with ulcers and peri anal disease |
Schistosoma | Extensive colitis, may be segmental with polyps |
Entamoeba | Acute colitis and ulcers |
Herpes | Proctitis with rectal ulcers and perianal disease |
Cytomegalovirus | Colitis with punched out shallow ulcers |
Aspergillus | Ulcers with bleeding |
Histoplasma | Predominantly right side colitis |
Table 2 Non infective causes of diarrhoea
Inflammatory | Behcet’s disease |
Drugs | Non streroidal anti inflammatory drugs |
Gold | |
Penicillamine | |
Iatrogenic | Radiation colitis |
Vascular | Vasculitis |
Ischaemic colitis | |
Neoplastic | Colorectal cancer |
Table 3 Endoscopic indices used in ulcerative colitis
0 | 1 | 2 | 3 | 4 | |
Sutherland | Normal | Mild friability | Moderate friability | Exudates and spontaneous haemorrhages | - |
Schroeder | Normal or inactive disease | Mild (erythema, decreased vascular pattern) | Moderate (marked erythema, absent vascular pattern) | Severe (spontaneous bleeding, ulceration) | - |
Baron | Normal: matt mucosa, ramifying vascular pattern, no spontaneous bleeding/to light touch | Abnormal, but non-haemorrhagic: appearances between 0-2 | Moderately haemorrhagic: bleeding to light touch, but no spontaneous bleeding | Severely haemorrhagic: spontaneous bleeding and bleeds to light touch | - |
Feagan | Normal, smooth, glistening mucosa, with normal vascular pattern | Granular mucosa; vascular pattern not visible; not friable; hyperaemia | As 1, with a friable mucosa, but not spontaneously bleeding | As 2, but mucosa spontaneously bleeding | As 3, but clear ulceration; denuded mucosa |
Powel- Tuck | Non haemorrhagic, no spontaneous bleeding or bleeding to light touch | Haemorrhagic, no spontaneous bleeding, but bleeding to light touch | Haemorrhagic, spontaneous bleeding ahead of instrument at initial inspection with bleeding to light touch | - | - |
Lemann, Hanauer | Normal mucosa | Oedema, +/- loss of vascular pattern, granularity | Friability, petechiae | Spontaneous haemorrhage, visible ulcers | - |
Table 4 Simple endoscopic score for Crohn’s disease
Variable | Simple endoscopic score | |||
0 | 1 | 2 | 3 | |
Size of ulcers | None | Aphthous ulcers | Large ulcers | Very large ulcers |
Ulcerated surface | None | < 10% | 10%-30% | > 30% |
Affected surface | Unaffected segment | < 50% | 50%-75% | > 75% |
Presence of narrowing | None | Single, scope passable | Multiple, scope passable | Scope impassable |
Table 5 Differences in the macroscopic appearance between Crohn’s disease and ulcerative colitis
Macroscopic features | UC | CD |
Erythema | +++ | ++ |
Loss of vascular pattern | +++ | + |
Granularity of mucosa | +++ | + |
Cobble stone appearance | - | ++ |
Pseudo polyps | +++ | +++ |
Aphthous ulcers | + | +++ |
Deep ulcers | - | +++ |
Patchy inflammation | - | +++ |
Ileal ulcers | - | +++ |
Rectal involvement | ++++ | ++ |
Table 6 Rutgeerts scoring system to monitor post surgery Crohn’s disease activity
Score | Endoscopic features |
i0 | Absence of any lesions at anastomosis and in the neo terminal ileum |
i1 | Less than 5 aphthous ulcers (< 5 mm) |
i2 | More than 5 ulcers with normal intervening mucosa or large patchy lesions, or lesions confined to anastomosis (< 1 cm) |
i3 | Diffuse aphthous ileitis with diffuse inflammation of the ileal mucosa |
i4 | Diffuse ileitis with large ulcers, nodularity and stenosis. |
- Citation: Rameshshanker R, Arebi N. Endoscopy in inflammatory bowel disease when and why. World J Gastrointest Endosc 2012; 4(6): 201-211
- URL: https://www.wjgnet.com/1948-5190/full/v4/i6/201.htm
- DOI: https://dx.doi.org/10.4253/wjge.v4.i6.201