No single test can confirm the diagnosis of inflammatory bowel disease, and clinicians often need to integrate multiple sources of information to make the diagnosis. In addition to history and physical examination, the diagnosis of inflammatory bowel disease usually requires a combination of colonoscopy and/or small bowel microscopy, as well as a barium meal small bowel imaging. Today, in many medical centers, small bowel barium meal imaging has been replaced by CTE. The main steps of CTE include oral dilation of the small intestine with a large amount (at least 1400 ml) of neutral contrast, contrast of the intestinal wall with the intestinal lumen, intravenous administration of iodine contrast, and acquisition of thin scan images of the abdomen and pelvis. The main manifestations of Crohn’s disease in CTE are: increased or asymmetrical intestinal wall thickness, marked intestinal wall enhancement, intestinal wall delamination, fibrofatty hyperplasia, increased mesenteric fat density, and comb-like signs. Many studies have concluded that CTE is significantly more sensitive to active small bowel inflammation than small bowel barium meal imaging, mainly because Crohn’s disease is a transmural lesion rather than just confined to the intestinal mucosa, and barium meal imaging does not fully reflect the disease condition. The imaging manifestations of CTE are highly consistent with Crohn’s disease activity and other endoscopic manifestations as well as serum CRP concentrations. A prospective study on the diagnosis of Crohn’s disease suggests that CTE is more sensitive and more specific than capsule endoscopy for active small bowel inflammation than ileoscopy and small bowel barium meal imaging. Also, CTE has significant advantages for occult small bowel strictures that can cause capsule endoscopic embolism. The disadvantages of CTE are: 1. It is not suitable for all patients with Crohn’s disease. Insufficient bowel tone or inability to tolerate intravenous contrast (renal impairment, severe contrast allergy) limit the use of CTE and patients must switch to other tests. 2. CTE is more expensive than small bowel barium meal, but this is clearly worth the cost in relation to the information and ultimate diagnostic benefit that CTE can provide. One study suggests that CTE can change the use of glucocorticoids in more than half of patients. 3. CTE leads to increased radiation exposure for patients. Patients receive three to four times more radiation during CTE than barium meal small bowel imaging, but this problem is now being addressed with advances in CT technology; and with improvements in MRI resolution, MRE (magnetic resonance enterography) is increasingly being used in clinical practice. CTE is a major advancement in small bowel imaging compared to small bowel barium meal imaging. Because it is highly sensitive to active small bowel inflammation and can detect extraluminal complications compared to capsule endoscopy, it has replaced barium meal small bowel imaging as the first-line imaging modality for small bowel disease in many centers.