Crohn's Disease Endoscopic Features

Crohn's disease is a chronic inflammatory condition that affects the gastrointestinal tract, and it presents with several characteristic findings during endoscopic evaluation. These features help differentiate it from other inflammatory bowel diseases such as ulcerative colitis.

Key Endoscopic Findings in Crohn's Disease

1. Mucosal Lesions

One of the earliest signs observed during endoscopy is the presence of mucosal abnormalities. These may include erosions, ulcers, or polypoid growths. The ulcers are often aphthous in nature or appear as linear ulcers aligned along the longitudinal axis of the intestine.

2. Deep and Longitudinal Ulcerations

Deep ulcers are a hallmark of Crohn's disease. These ulcers typically extend along the length of the intestinal wall and are often longer than 4 cm. This pattern of ulceration is considered a classic endoscopic feature of the disease.

3. Inflammatory Proliferation and Cobblestone Appearance

Surrounding areas of severe ulceration may show signs of inflammatory tissue growth, leading to a characteristic "cobblestone" or "paved stone" appearance. This occurs due to the formation of elevated ridges of inflamed tissue separated by deep ulcers, creating a texture similar to cobblestone streets.

4. Segmental Involvement

Crohn's disease often presents with a patchy or segmental pattern of inflammation, where affected areas are interspersed with regions of normal mucosa. This skip lesion pattern is a key distinguishing factor from ulcerative colitis, which typically involves continuous inflammation of the colon.

5. Fistulas and Perianal Disease

In some cases, patients may develop abnormal connections between the intestines and other organs or the skin, known as fistulas. Perianal fistulas and abscesses are particularly common in Crohn's disease and can significantly impact the patient's quality of life.

6. Terminal Ileum Involvement

The terminal ileum is frequently affected in Crohn's disease. Endoscopic examination may reveal narrowing of the intestinal lumen due to inflammation or the presence of ulcerative lesions in this region. This involvement is another key differentiator from ulcerative colitis, which typically affects the rectum and extends proximally without involving the small intestine.