The diagnosis of Crohn's<unk>  can sometimes be challenging, and many tests are often required to assist the physician in making the diagnosis. Even with a full battery of tests, it may not be possible to diagnose Crohn's with complete certainty; a colonoscopy is approximately 70% effective in diagnosing the<unk> , with further tests being less effective.<unk>  in the small bowel is particularly difficult to diagnose, as a traditional colonoscopy allows access to only the colon and lower portions of the small intestines; introduction of the capsule endoscopy aids in endoscopic diagnosis. Giant (multinucleate) cells, a common finding in the lesions of Crohn's<unk> , are less common in the lesions of lichen nitidus. CD colitis.Endoscopic image of Crohn's colitis showing deep<unk> ation CT scan gastric CD.CT scan showing Crohn's<unk>  in the fundus of the stomach CD colitis 2.Endoscopic biopsy showing granulomatous inflammation of the colon in a case of Crohn's<unk> . Crohn's transmural path.Section of colectomy showing transmural inflammation ResectedIleum.Resected ileum from a person with Crohn's<unk>  Classification Distribution of gastrointestinal Crohn's<unk> . Crohn's<unk>  is one type of inflammatory bowel<unk>  (IBD). It typically manifests in the gastrointestinal tract and can be categorized by the specific tract region affected. A<unk>  of both the ileum (the last part of the small intestine that connects to the large intestine), and the large intestine, Ileocolic Crohn's accounts for fifty percent of cases. Crohn's ileitis, manifest in the ileum only, accounts for thirty percent of cases, while Crohn's colitis, of the large intestine, accounts for the remaining twenty percent of cases and may be particularly difficult to distinguish from<unk> ative colitis. Gastroduodenal Crohn's<unk>  causes inflammation in the stomach and the first part of the small intestine called the duodenum. Jejunoileitis causes spotty patches of inflammation in the top half of the small intestine, called the jejunum. The<unk>  can attack any part of the digestive tract, from mouth to anus. However, individuals affected by the<unk>  rarely fall outside these three classifications, with presentations in other areas. Crohn's<unk>  may also be categorized by the behavior of<unk>  as it progresses. These categorizations formalized in the Vienna classification of the<unk> . There are three categories of<unk>  presentation in Crohn's<unk> : stricturing, penetrating, and inflammatory. Stricturing<unk>  causes narrowing of the bowel that may lead to bowel obstruction or changes in the caliber of the feces. Penetrating<unk>  creates abnormal passageways (fistulae) between the bowel and other structures, such as the skin. Inflammatory<unk>  (or nonstricturing, nonpenetrating<unk>  causes inflammation without causing strictures or fistulae. Endoscopy A colonoscopy is the best test for making the diagnosis of Crohn's<unk> , as it allows direct visualization of the colon and the terminal ileum, identifying the pattern of<unk>  involvement. On occasion, the colonoscope can travel past the terminal ileum, but it varies from person to person. During the procedure, the gastroenterologist can also perform a biopsy, taking small samples of tissue for laboratory analysis, which may help confirm a diagnosis. As 30% of Crohn's<unk>  involves only the ileum, cannulation of the terminal ileum is required in making the diagnosis. Finding a patchy distribution of<unk> , with involvement of the colon or ileum, but not the rectum, is suggestive of Crohn's<unk> , as are other endoscopic stigmata. The utility of capsule endoscopy for this, however, is still<unk> tain. A "cobblestone"-like appearance is seen in approximately 40% of cases of Crohn's<unk>  upon colonoscopy, representing areas of<unk> ation separated by narrow areas of healthy tissue. Radiologic tests A small bowel follow-through may suggest the diagnosis of Crohn's<unk>  and is useful when the<unk>  involves only the small intestine. Because colonoscopy and gastroscopy allow direct visualization of only the terminal ileum and beginning of the duodenum, they cannot be used to evaluate the remainder of the small intestine. As a result, a barium follow-through X-ray, wherein barium sulfate suspension is ingested and fluoroscopic images of the bowel are taken over time, is useful for looking for inflammation and narrowing of the small bowel. Barium enemas, in which barium is inserted into the rectum and fluoroscopy is used to image the bowel, are rarely used in the work-up of Crohn's<unk>  due to the advent of colonoscopy. They remain useful for identifying anatomical abnormalities when strictures of the colon are too small for a colonoscope to pass through, or in the detection of colonic fistulae (in this case contrast should be performed with iodate substances). CT and MRI scans are useful for evaluating the small bowel with enteroclysis protocols. They are also useful for looking for intra-abdominal complications of Crohn's<unk> , such as abscesses, small bowel obstructions, or fistulae. Magnetic resonance imaging (MRI) is another option for imaging the small bowel as well as looking for complications, though it is more expensive and less readily available. MRI techniques such as diffusion-weighted imaging and high-resolution imaging are more sensitive in detecting<unk> ation and inflammation compared to CT. Blood tests A complete blood count may reveal anemia, which commonly is caused by blood loss leading to iron deficiency or by vitamin B deficiency, usually caused by ileal<unk>  impairing vitamin B absorption. Rarely autoimmune hemolysis may occur. Ferritin levels help assess if iron deficiency is contributing to the anemia. Erythrocyte sedimentation rate (ESR) and C-reactive protein help assess the degree of inflammation, which is important as ferritin can also be raised in inflammation. Serum iron, total iron binding capacity and transferrin saturation may be more easily interpreted in inflammation. Anemia of chronic<unk>  results in a normocytic anemia. Other causes of anemia include<unk> ion used in treatment of inflammatory bowel<unk> , like azathioprine, which can lead to cytopenia, and sulfasalazine, which can also result in folate deficiency. Testing for Saccharomyces cerevisiae antibodies (ASCA) and antineutrophil cytoplasmic antibodies (ANCA) has been evaluated to identify inflammatory<unk> s of the intestine and to differentiate Crohn's<unk>  from<unk> ative colitis. Furthermore, increasing amounts and levels of serological antibodies such as ASCA, antilaminaribioside Glc(β1,3)Glb(β); ALCA, antichitobioside GlcNAc(β1,4)GlcNAc(β); ACCA, antimannobioside Man(α1,3)Man(α)AMCA, antiLaminarin (Glc(β1,3))3n(Glc(β1,6))n; anti-L and antichitin GlcNAc(β1,4)n; anti-C associate with<unk>  behavior and surgery, and may aid in the prognosis of Crohn's<unk> . Low serum levels of vitamin D are associated with Crohn's<unk> . Further studies are required to determine the significance of this association. Comparison with<unk> ative colitis The most common<unk>  that mimics the symptoms of Crohn's<unk>  is<unk> ative colitis, as both are inflammatory bowel<unk> s that can affect the colon with similar symptoms. It is important to differentiate these<unk> s, since the course of the<unk> s and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the<unk>  is classified as indeterminate colitis. Differential diagnosis Other conditions with similar symptoms as Crohn's<unk>  includes intestinal tuberculosis, Behçet's<unk> ,<unk> ative colitis, nonsteroidal anti-inflammatory drug enteropathy, irritable bowel syndrome and celiac<unk> . Irritable bowel syndrome is excluded when there are inflammatory changes. Celiac<unk>  cannot be excluded if specific antibodies (anti-transglutaminase antibodies) are negative, nor in absence of intestinal villi atrophy.
medical cause of Peptic ulcer disease
symptoms of Helicobacter pylori
medical cause of Gastritis
symptom of Helicobacter pylori
symptom of Ulcerative colitis
symptom of Small intestine cancer
symptom of Stomach cancer
complications of Helicobacter pylori