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Evaluation of the Small Bowel
The rapid development of imaging and histopathologic techniques, in conjunction with an altered pattern of disease and treatments late in the 20th century, has changed the “standard” of testing for small bowel function and anatomy. Testing has now become a sophisticated evaluation performed for outpatients in most clinical practices and in detail at university research centers. Evaluation of the patient thought to have small bowel disease should include the following:
- 1.
Detailed history and physical examination for clues to etiology and physical findings of malabsorption
- 2.
Careful imaging technique
- 3.
Biopsy of the small intestine if needed
- 4.
Biochemical function evaluation
- 5.
Stool analysis for parasitic and infectious etiologies
Key findings in the history and physical examination and analysis are described under each disease. However, small bowel disease must be suspected whenever a patient experiences weight loss, diarrhea, anemia, or any sign or symptom of a selective malabsorption deficiency.
Imaging Techniques
In the 20th century, the barium contrast study was used to demonstrate the classic malabsorption pattern, including loss of normal small bowel folds, dilatation of the bowel, and segmentation of the meal. Subtle and dramatic presentations were often recorded. In addition, other defects of the small bowel—including neoplasia, strictures, and diverticula—were frequently demonstrated.
The development of computed tomography (CT) and enterography now allows sophisticated imaging of select areas of the bowel and demonstrates the thickness of the bowel wall and any reaction outside the bowel wall. CT has enhanced the clinician's ability to evaluate for many diseases. At times, however, it is still necessary to do both barium contrast and CT studies.
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