Current and future diagnostic approaches: from serologies to imaging.
Advances in serologic markers and imaging modalities continue to revolutionize diagnostic approaches to inflammatory bowel disease (IBD). Autoimmune and antimicrobial antibodies demonstrate diagnostic value in those patients with a moderate pretest probability of disease. Emerging data also support the use of antimicrobial antibody levels as a predictive tool for small bowel complications and the need for future surgery. In addition to being a prognostic marker in patients with acute severe colitis, serum C-reactive protein has been shown to correlate with clinical, endoscopic, and radiologic measures of disease activity. Capsule endoscopy and double-balloon endoscopy allow for visualization of the entire small bowel, and double-balloon endoscopy also has the capability to treat lesions. CT enterography is beginning to replace small bowel follow-through because of its high sensitivity and specificity for disease of the small intestine. Both CT and magnetic resonance enterography detect luminal and extraluminal abnormalities, with MRI serving as a safe imaging option in cases of pregnancy and renal insufficiency. These newer modalities add to the armamentarium clinicians can use for evaluation of IBD.
Bruining
David H
DH
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
Loftus
Edward V
EV
D000906:Antibodies / Q000032:analysis; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D053704:Capsule Endoscopy; D023881:Colonography, Computed Tomographic; D003952:Diagnostic Imaging; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D000906:Antibodies; D019268:Antibodies, Antineutrophil Cytoplasmic; D002097:C-Reactive Protein