Testing & Imaging
After a colonoscopy, your gastroenterologist hands you a report filled with clinical terminology that can feel impossible to parse. Words like "aphthous ulceration," "skip lesions," and "cobblestoning" may appear alongside scoring systems you have never heard of. Understanding what these terms mean can help you have more productive conversations with your care team and stay informed about how your Crohn's disease is actually behaving beneath the surface. This guide breaks down the most common findings in a Crohn's colonoscopy report so you know what you are looking at.
What a Colonoscopy Report Includes
A standard colonoscopy report for Crohn's disease covers several categories of information. First, it describes the extent of examination, noting how far the scope reached (ideally into the terminal ileum, since Crohn's commonly affects this area). Next, it documents the mucosal appearance of each bowel segment, describing whether the tissue looks normal, inflamed, or ulcerated. The report also notes the pattern of disease, particularly whether inflammation is continuous or patchy. Finally, it records whether biopsies were taken and from which locations. Your doctor may also include an endoscopic severity score, which quantifies the degree of inflammation observed. Understanding these sections gives you a framework for interpreting the specific findings described below (Healthgrades, 2024).
Common Findings and What They Mean
Several terms appear frequently in Crohn's colonoscopy reports. Aphthous ulcers are small, shallow sores that often represent early or mild inflammation. As disease progresses, these can merge into longitudinal ulcers, which are larger, elongated sores that run along the length of the intestinal wall. Deep or circumferential ulcers indicate more advanced disease and may extend through the full thickness of the bowel wall (PMC, 2008).
Skip lesions refer to the characteristic Crohn's pattern of inflamed segments separated by stretches of normal-looking tissue. This patchy distribution is one of the features that distinguishes Crohn's from ulcerative colitis, which typically causes continuous inflammation.
Cobblestoning describes a textured, uneven mucosal surface created when deep ulcers surround islands of swollen but intact tissue. This finding suggests moderate to severe inflammation. Strictures are narrowed areas of the intestine, caused by chronic inflammation and scarring, that can eventually obstruct the passage of food and waste. If your report mentions a stricture, your doctor will likely discuss whether it is inflammatory (potentially reversible with medication) or fibrotic (may require procedural intervention) (HealthCentral, 2024).
Understanding Pseudopolyps
Pseudopolyps are raised bumps of tissue that appear on the intestinal wall, and seeing them in your report can be alarming. Despite the name, they are not true polyps and are generally not precancerous. They form when areas of mucosa regenerate unevenly after repeated cycles of inflammation and healing. Researchers have distinguished between "inflammatory" pseudopolyps, which are associated with active disease, and "healed" pseudopolyps, which are projecting masses of scar tissue found in patients who have reached endoscopic remission (PMC, 2017). Your gastroenterologist may still biopsy pseudopolyps to rule out dysplasia, particularly if they appear irregular in shape or size. A recent study found dysplasia in about 12% of endoscopically resected pseudopolyps, so ongoing surveillance remains important (Oxford Academic, 2025).
The SES-CD Score and Why It Matters
Many colonoscopy reports now include the Simple Endoscopic Score for Crohn's Disease (SES-CD), a standardized way to measure how much inflammation is visible. The score evaluates four variables across five bowel segments (terminal ileum, ascending colon, transverse colon, descending colon and sigmoid, and rectum). Those four variables are: the size of ulcers, the proportion of surface covered by ulcers, the proportion of surface affected by any other lesion, and the presence of narrowing (stenosis) (PMC, 2016).
The total SES-CD score helps classify disease activity. A score of 0 to 2 generally indicates remission. Scores of 3 to 6 suggest mild endoscopic activity, 7 to 15 indicate moderate activity, and scores above 15 reflect severe disease. Research published in 2025 found that patients with an SES-CD of 7 or higher had a significantly greater risk of disease progression over two and five years compared to those in remission (PMC, 2025). This is why tracking your SES-CD over time provides meaningful data about whether your treatment is working at the tissue level.
What Mucosal Healing Looks Like
The ultimate treatment goal in Crohn's disease has shifted from symptom control alone to mucosal healing, meaning the intestinal lining looks normal or near-normal on endoscopy. A report showing no ulcers, no active inflammation, and an SES-CD of 3 or below is consistent with endoscopic remission. Mucosal healing is associated with lower rates of hospitalization, surgery, and disease flares over time (AAFP, 2018).
However, symptoms do not always match what the scope reveals. You can feel well while inflammation quietly persists, or you can have ongoing symptoms despite healed mucosa (which may point to other overlapping conditions like irritable bowel syndrome). This disconnect is exactly why colonoscopy reports matter so much. They show what is happening in the tissue, independent of how you feel day to day.
Tracking Your Results Over Time
A single colonoscopy report is a snapshot. Its real value emerges when you compare it to previous reports and track changes across months and years. Are your ulcers smaller or gone? Has your SES-CD score dropped? Have strictures stabilized or progressed? These trends tell a story about whether your current treatment is achieving mucosal healing or whether adjustments are needed.
Log your colonoscopy results in Aidy after each scope. Tracking your endoscopic findings over time shows whether your treatment is achieving mucosal healing, not just symptom control. Having this data organized and accessible means you walk into your next gastroenterology appointment ready to have an informed conversation about where your disease stands and what comes next.