Small intestinal ulceration

The differential diagnoses of ulcers of the small bowel are well known. They include Crohn disease, non - steroidal anti - infl ammatory drugs (NSAIDs), radiation, vasculitis, medication effects, some infections, and certain neoplasms. Yet when faced with the fi nding of ulceration in the small bowel, it can be diffi cult to come up with a fi nal diagnosis. Crohn disease is most common but NSAID use is also very common. Then, how does a physician make the diagnosis of Crohn disease by the presence of ulcers seen only on endoscopy, capsule or otherwise? In the past, we were confi dent making the diagnosis in the clinical setting of pain and diarrhea in a young person in whom a small bowel series shows ileitis. We clearly should be able to do the same with endoscopic fi ndings. That is to combine the clinical scenario with the endoscopic, instead of the radiographic, fi ndings. There can be other evidence to support our diagnosis of Crohn disease including a family history of infl ammatory bowel disease and abnormal serologies of antineutrophil cytoplasmic antibodies and anti - Saccharomyces cerevisiae antibodies, though this is not the intended use of these blood tests. Endoscopic biopsy typically cannot differentiate a Crohn ulcer from an NSAID ulcer. Other testing such as computed tomography scanning generally provides no additional information to endoscopy. Grading severity of infl ammatory fi ndings on capsule endoscopy can provide more certainty to making a fi nal diagnosis.