Tales from the Crypt

How a group of international researchers aim to redefine mucosal disease

Published in Inside Tract - Summer 2016

As endoscopy advances through increasingly better imaging, Mark Lazarev and colleagues think it’s time for diagnosis to catch up with the technology.

Lazarev, a Johns Hopkins gastroentrologist who specializes in inflammatory bowel disease, and researchers from seven other centers globally will soon embark on a study aimed at redefining aspects of mucosal disease.

“Specifically,” says Lazarev, “we need to change how we discuss mild IBD.” 

Severe disease is easy to spot, he says. “Even without the latest scopes, we had little trouble identifying and describing cases. But milder forms have given us problems, because there were so many things we couldn’t see.”

With current high-def microscopy, however, endoscopists can survey the individual intestinal glands called crypts—10 million of which line the epithelial inner surface of the organ. The first signs of disease can be elongation or irregular crypts. Crypt abscesses are also now entirely visible.

As just one example of the need to reframe the discussion around IBD, Lazarev points to the common diagnosis of “loss of vasculature.” For years, “we thought we were looking at vessels obliterated by disease,” he says.

But new cameras have proven there’s no loss of vasculature in patients with the disease—merely disrupted vessels. Meanwhile, the language has yet to reflect what endoscopists can now see for themselves.

The first-of-its-kind multicenter study will involve taking videos and pictures within the most diseased segments of the rectum and sigmoid, which will be scored by a number of IBD experts according to a new grading system developed to improve specificity of diagnosis. “We’ll also take a biopsy right at the site,” says Lazarev, “to further correlate it.