Dramatic changes in the technology of diagnostic imaging and management of Crohn's disease

The appropriate therapy for Crohn's disease (CD) cannot be achieved until the extent of disease and its anatomical importance are taken into consideration. Therefore, information from imaging tests is essential to establish a diagnosis. A single gold standard for the diagnosis of CD is not available. The diagnosis should be made by clinical evaluation and a combination of endoscopic, histological, radiological, and/or biochemical investigations. In the case of patients with suspected CD in whom stenosis is not confirmed, if ileocolonoscopy and radiological examination/cross-sectional imaging show no lesion or they are difficult to conduct, small bowel capsule endoscopy is applicable. Radiological examination, especially, double-contrast imaging of the small intestine is one of the best tools for the evaluation of mucosal and transmural lesions and this technique is thought to be necessary to understand the past and present disease status. Double balloon enteroscopy should be reserved for specific situations in which biopsy samples from suspected involved areas are important for diagnosis or in which a dilatation of stricture is reasonable.