Endoscopy in Inflammatory Bowel Disease: Asian Perspective—Korea

Abstract

With the increasing incidence of inflammatory bowel disease (IBD) over the past few decades, the proper diagnosis and treatment of IBD are being emphasized in Korea. Recently, several Korean studies have addressed the role of endoscopy in the management of IBD. In contrast to traditional conceptions, the atypical distribution of inflammation is not infrequently observed in patients with ulcerative colitis (UC). Appendiceal skip inflammation is common in patients with UC and may precede typical features of UC development, but it does not seem to be related to the clinical course. Intestinal tuberculosis (ITB) is still prevalent in Korea, and must be differentiated from Crohn’s disease (CD). In a colonoscopy, anorectal lesions, longitudinal ulcers, aphthous ulcers, and a cobblestone appearance are more commonly observed in CD, whereas the involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps suggest ITB rather than CD. In up to 90% of cases, it was possible to correctly diagnose CD and ITB using a simple scoring system with the above eight parameters. A mycobacterial culture assay with colonoscopic biopsy specimens must be performed to aid the diagnosis of ITB in suspected cases. Isolated terminal ileal ulcerations not diagnosed with CD, ITB, or nonsteroidal anti-inflammatory agent-associated enteropathy remain an area of uncertainty. However, their prognosis appears favorable without progression to a significant condition in most cases; thus, over-diagnosis and/or over-treatment should be avoided.