Inflammatory bowel disease (IBD) requires frequent imaging-based assessment, yet interpretation of modalities such as wireless capsule endoscopy (WCE) and intestinal ultrasound remains heavily dependent on specialist expertise. Vision-Language Models (VLMs) demonstrate significant potential in multimodal medical image analysis, but their clinical adoption is hindered by their insufficient domain-specific reasoning, susceptibility to hallucination, scarcity of high quality training data in fine-grained diagnostics and limited interpretability. We introduce ARISE (Adaptive Agentic Reasoning with Image-grounded Self-Evaluation), an autonomous planning framework that models few-shot medical image understanding as a sequential agentic workflow. ARISE structures agent execution into a transparent 5-stage workflow: hypothesis generation, image-grounded evidence summarization, evidence-conditioned refinement, symbolic verification, and final diagnosis. We apply ARISE to IBD assessment across two independent patient cohorts: wireless capsule endoscopy (WCE) images for Crohn's disease and B-mode ultrasound data for ulcerative colitis. ARISE consistently improves diagnostic performance over baseline VLMs while exposing where reasoning succeeds or fails, providing a more interpretable basis for clinical decision support and realistic deployment.

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