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Scoping the Small Bowel in Patients with Crohn’s Disease

scopeIn up to 20 percent of patients with Crohn’s disease, the disease is isolated to an area of the small bowel that is out of reach of an upper endoscopy (a procedure where a scope is passed through the patient’s mouth and into the esophagus, stomach and upper part of the small intestine) or a colonoscopy (a procedure where a tube is inserted into the patient’s rectum and passed through the colon). This makes getting a proper diagnosis challenging. Without a correct diagnosis, we can’t know if we are treating the right disease.

We have made strides in imaging techniques that allow us to see a patient’s small bowel. During a capsule endoscopy the patients swallows a pill-sized camera. As the capsule passes through the patient’s body, images are taken and transmitted to a recording device. These images allow us to look for subtle changes in the small bowel that can indicate Crohn’s disease.

A double-balloon enteroscopy (DBE) is another technique that allows us to not only diagnose, but also treat complications of Crohn’s. During this procedure, a small tube with a camera is threaded either through the patient’s mouth or rectum and into the small bowel. This allows the doctor to take tissue samples that can help with a proper diagnosis.

DBE also allows us to treat abnormalities called strictures in the bowel. A stricture is a narrowing of an area of the bowel. Severe strictures can cause a partial or complete bowel blockage. During DBE, we inflate a small balloon in the area where we find a stricture to open up that section of the bowel. Before we had DBE, strictures could only be treated surgically. DBE is an outpatient procedure that’s proven to be highly effective in strictures that are less than 5 cm long.

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RiceDr. Michael David Rice went to Wayne State University School of Medicine. He completed an internship in internal medicine and a fellowship in internal medical gastroenterology at the University of Virginia Hospitals. He is board certified in gastroenterology. His research interests include small bowel imaging techniques, including double-balloon enterescopy and capsule endoscopy in the diagnosis and management of IBD and obscure GI bleeding. Dr. Rice sees patients at the Taubman Center, East Ann Arbor Ambulatory Surgery and Medical Procedures Center, Brighton Health Center and the University of Michigan Hospital.

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