Do you think my colonoscopies should be performed by internal medicine doctors or gastroenterologists? I have a history of Crohn's colitis.

T.

Crohn's disease is a chronic inflammatory disease typically affecting the small intestine and/or colon. Symptoms include diarrhea, bleeding from the rectum, weight loss and abdominal pain. Often the diagnosis of Crohn's disease is made when the patient is referred for a colonoscopy after his or her doctor has suspected this disease on the basis of the symptoms mentioned. The colonoscopic appearance of colitis (whether due to Crohn's or another cause) may include evidence of swelling and inflammation of the colon lining, as well as scarring and bleeding. In severe cases, deep ulcers may be seen.

After the diagnosis is made and therapy for colitis is begun, there may be instances when a colonoscopy may need to be repeated. For example, if the patient is doing well on medications and then has a flare-up of Crohn's disease, a colonoscopy (or more often, a sigmoidoscopy) may be done to rule out an infection. At other times, a colonoscopy is done to evaluate the full extent of the colitis to better plan the therapy. This is especially true if the initial colonoscopy was not complete, as often happens if the disease was especially active when the exam was done. Finally, when patients have had colitis for more than eight to 10 years, regular colonoscopies are recommended at every year or two to screen for colon cancer. Patients with longstanding colitis are at higher risk for colon cancer, and this risk increases with the duration of disease.

Although many internal medicine doctors perform sigmoidoscopy (which examines the rectum and left side of the colon), most are not trained to perform full colonoscopy. This exam is more complex, requires IV sedation and is technically more difficult. Gastroenterologists have specific training in all endoscopic procedures and perform colonoscopies routinely. In addition, they are trained to recognize the endoscopic appearance of the various colonic diseases and can make important diagnostic and therapeutic decisions based on these findings.