Crohn’s Disease: The Small Bowel Meal and Pneumocolon

Crohn’s disease is an idiopathic inflammatory condition of the bowel. It can affect the entire gastrointestinal tract. The disease is characterized by discontinuous ulcerations that tend to be longitudinal and transverse in orientation. This results in a cobblestone appearance of the mucosa. The earliest macroscopic findings are tiny aphthous ulcers or erosions. These lead to deeper irregular ulcers, strictures, and fistulae. The course of the disease can be influenced to a certain extent by early diagnosis. As Crohn’s disease was first recognized in the small bowel, a barium examination was developed to facilitate the diagnosis. The majority of the patients have disease in the distal ileum. Only about 5% have the disease proximal to the distal ileum. Therefore, for any study to make an early diagnosis, it has to optimally image the distal ileum.