Diagnosis of Inflammatory Diseases of the Colon: Comparative Endoscopic and Roentgenological Examinations

Abstract

In a total of 409 patients with inflammatory disease of the colon information provided by colonoscopy with biopsy and barium contrast enema was compared. In 156 of these patients the cndoscopic diagnosis was ulcerative colitis, the results of biopsy showed agreement in 111 of 141 patients (78.2 °/o). Radiological confirmation of ulcerative colitis diagnosed endoscopically (n = 122) was possible in 49.2 °/o (n 60) in respect of diagnosis, and in 21.3 °/o (n = 26) with regard to the localization of the disease. In 89 patients with ulcerative colitis demonstrated by colonoscopy and biopsy, an agreement in respect of diagnosis was found in 55.1 °/o (n = 49) and with regard to the extent of the disease, in 27 0/o (n = 24). Crohn's disease of the colon was diagnosed in 206 patients at colonoscopy. On the basis of biopsy, granulomas were demonstrated in up to 26.9 °/o. In 125 patients with Crohn's disease verified at colonoscopy, the double-contrast barium enema revealed the diagnosis in 56.8 s/o (n = 71). The two methods disagreed with respect to the extent of the disease in 72.8 °/o (n = 91) of the cases. Despite the proven greater accuracy of endoscopy plus biopsy, the double contrast enema technique remains a diagnostic procedure, the possibilities of which should be made use of, in particular within the framework of initial examinations. Normal X-ray film of the colon, however, does not exclude the presence of inflammatory changes in the colon. Colonoscopy with biopsy provides additional information in a high percentage of the patients.

Plain X-Ray Films and Air Enema Films Reflect Severe Mucosal Inflammation in Acute Ulcerative Colitis

“…Our finding of a more limited disease extent on air enema films compared to colonoscopy findings is in contrast to that but in agreement with other X-ray studies. Double contrast barium enema X-ray underestimates the extent of colitis compared with colonoscopy [3,[23][24][25][26][27], even if occasionally good agreement has been reported [28].…”

“…In this study, however, mild degrees (grade 1) of endoscopically inflamed mucosa were present in half of the segments with normal findings on air enema X-ray. Other radiologic methods also underestimate mucosal involvement [3,[23][24][25][26][27][29][30][31], On the other hand, the positive predictive value of an abnormal air enema X-ray film was high, and, in almost every case, an indicator of endoscopic inflammation.…”

The clinical yield of colonoscopy

“…In many patients with colitis appropriate treatment of more severely affected areas, as demonstrated on Xray, can be clinically very adequate. It may even be counterproductive to know from endoscopy that the proximal colon is mildly abnormal (Lux et al, 1978;Gabrielsson et al, 1979) in patients radiologically assessed as having distal colitis, who can be expected to respond to corticosteroid enemas, do not need oral therapy and probably do not share the long-term cancer risk of true 'total colitis' patients.…”