Rectal endosonography in inflammatory bowel disease: Differential diagnosis and prediction of remission

Background and Study Aims: There are few and conflicting data on EUS featur es of the rectal mall in Crohn's disease (CD) and ulcerative colitis (UC). The aim of our study was to determine whether rectal EUS could first differ entiate between CD and UC, and secondly predict remission in CD. Patients and Methods: During a 14 month period we prospectively and blindly studied several parameters on rectal EUS (total,wall thickness, mucosal ap pearance, submucosal thickness, number of enlarged vessels in the submucosa and number of pathological lymph nodes around the rectum and sigmoid colon ) in 20 normal subjects, 26 patients with UC, 39 patients with CD, and four with infectious colitis. Comparisons,were made between normal controls, pa tients with acute UC and those with acute CD, as well as between acute flar e-ups and quiescent forms of CD and UC in the same patients. Results: Normal subjects showed some features which were significantly diff er ent from those in CD or UC patients. A greater number of pathological ly mph nodes was characteristic for acute UC, whereas the number of enlarged v essels was increased in acute CD. Quiescent CD showed a lower amount of wal l thickening than acute CD. No significant alterations of the five paramete rs were found in quiescent UC compared to acute UC. Conclusions: This study suggests that EUS could be helpful in differentiati ng acute UC from CD, and to predict remission in CD.