What is the role of small bowel follow-through (SBFT) in the diagnosis of Crohn disease?

Updated: Jul 26, 2019
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

An upper GI SBFT and spot films of the terminal ileum can be used to assess the small bowel of patients with suspected Crohn disease. SBFT can also detect alteration of the small bowel wall indirectly (through findings such as enteroenteric and enterocolonic fistulization.

Radiographic findings in both the small and the large bowel parallel the clinical pattern. Edema and ulceration of the mucosa in the small bowel may appear as thickening and distortion of valvulae conniventes. Edema of the deep layers of the bowel wall results in separation of the barium-filled bowel loops. Tracking of deep ulcerations, both transversely and longitudinally, results in a cobblestone appearance (see the image below).

Cobblestoning in Crohn disease. Spot view of the t Cobblestoning in Crohn disease. Spot view of the terminal ileum from a small bowel follow-through study demonstrates linear longitudinal and transverse ulcerations that create a cobblestone appearance. Also, note the relatively greater involvement of the mesenteric side of the terminal ileum and the displacement of the involved loop away from the normal small bowel secondary to mesenteric inflammation and fibrofatty proliferation.

Ileitis can also manifest as a string sign on barium studies secondary to spasm or, rarely, because of fibrotic stricture (see the following images).

Crohn disease of terminal ileum. Small bowel follo Crohn disease of terminal ileum. Small bowel follow-through study demonstrates the string sign in terminal ileum. Also, note pseudodiverticula of the antimesenteric wall of terminal ileum, secondary to greater distensibility of this less-involved wall segment.
Spot view of the terminal ileum from a small bowel Spot view of the terminal ileum from a small bowel follow-through study in a patient with Crohn disease demonstrates the string sign, consistent with narrowing and stricturing. Also, note a sinus tract originating from the medial wall of the terminal ileum and the involvement of the medial wall of the cecum.

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