HOW IS IBD RECOGNIZED AND DIAGNOSED?

It's important to correctly recognize Crohn's disease, ulcerative colitis (UC) and the other intestinal problems that are inflammatory bowel disease (IBD) and to make sure you receive the best treatment for you, since every one is different.  

Several steps are involved:

• Review the symptom pattern 
• Initial Blood and Stool Tests
• Colonoscopy and Endoscopy
• Xrays and Imaging

Reviewing the Symptom Pattern

Sometimes, the symptoms and their pattern can help to tell the difference between Crohn's disease, UC and IBS. If there is rectal or perianal disease, that is usually a telltale sign of Crohn's disease and can help to make the diagnosis. If there's blood present, that helps to rule out IBS as a cause. All of the other symptoms can occur with any of these diseases, though the location of the pain and the amount of diarrhea can give some indication, though these are all just indications and formal testing is needed.

Initial Blood and Stool Tests

Testing the Blood and Stool (bowel movements) are done for 3 main reasons

• To point us toward a diagnosis and rule out other causes of the symptoms
• To judge the severity
• To determine whether there are associated problems

The typical blood and stool tests are specific in what they look for. But they have to be interpreted carefully. For example, a test for anemia can tell whether someone has enough healthy red blood cells to carry oxygen around the body, but alone, it doesn't tell us the cause  

Certain blood and stool tests are used most often to see whether IBD might be present and monitor progress. But by themselves, these blood tests and stool samples cannot make the diagnosis of IBD Crohn's disease or ulcerative colitis.  

X-rays and Imaging

X-rays in different forms provide a picture of the abdomen (that area between the chest and the hips), the various organs inside (including most of the gastrointestinal tract), and some of the problems that can be present. But just like a picture, they are two dimensional. And depending on how sharp and how big the image is, details can be seen or missed. 

Patients are often given contrast (like barium for routine xrays) to fill the inside of the intestine and outline its structure. Other contrast materials can be given for CT scan and MRIs, which are less bothersome, but several glassfuls are still required to assure that the entire intestine can be well seen.

Because radiation is needed for x-rays and scans, and these tests are often repeated over the years with patients accumulating radiation exposure, MRIs are being used more often, though they are are more expensive and time consuming, because they do not require radiation and often give better detail of active disease.    

Endoscopy 

Colonoscopies have become common to screen for cancer in older adults, but they are also the best tool for diagnosing and tracking UC. Colonoscopies are also the standard method for diagnosing Crohn's disease in the large intestine and at the end of the small intestine (the terminal ileum). Because that is as far as standard scopes can reach, colonoscopy cannot recognize disease in the majority of the small intestine. This requires either an x-ray study or capsule endoscopy (often called the pill camera). Because IBD can also affect the stomach and esophagus, an upper scope may be performed at the same time.

Some people are concerned about the risk of a colonoscopy, but they are quite safe.