How Inflammatory Bowel Disease Is Diagnosed

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Inflammatory bowel disease (IBD) is a type of chronic bowel disease that includes ulcerative colitisCrohn's disease, and indeterminate colitis. Its symptoms—abdominal pain, diarrhea, and bloody or mucousy stools—can mimic other gastric conditions, so it is important to get an accurate diagnosis to get the proper treatment so you can start feeling better.

An IBD diagnosis is based on symptoms, history, bloodwork, and diagnostic imaging. The tests are used to rule out other conditions as well as distinguish between different forms of IBD, either Crohn’s disease or ulcerative colitis. It can take time to get an accurate diagnosis.

For severe symptoms, or those that are causing significant stress or are incapacitating, see a physician as soon as possible.

In the case of severe abdominal pain, significant bleeding or suspected dehydration, seek immediate medical attention.

At-Home Tests

IBD can be difficult to diagnose, but the first clue is often the symptoms:

If you have these or other gastrointestinal symptoms, such as vomiting, fatigue, headaches, and weight loss, it can be helpful for you to keep a daily journal. or track symptoms on a smartphone app.

Keeping a detailed log of symptoms is more effective than memory recall when describing symptoms to your doctor and can help patterns emerge.

Bring the logs to your doctor who can help determine if there's a need to see a gastroenterologist, which is a physician who specializes in the digestive tract. A gastroenterologist will take a history of any IBD symptoms and conduct tests.

Depending on the symptoms, your doctor may test for conditions that occur along with IBD, such as arthritis, or to rule out other illnesses.

Labs and Tests

Your doctor will decide the right tests for you based on your medical history, family history, and symptoms. The first tests that may be done are blood tests and a stool test, including:

Complete Blood Count (CBC)

The CBC count can include a check of the white blood cell (WBC) count and the red blood cell (RBC) count.

A high WBC count may be a sign that there is inflammation somewhere in the body. A low RBC count could be a sign of internal bleeding. Subsequent RBC counts are also used to measure blood loss.

Electrolyte Panel

An electrolyte panel measures the level of sodium, potassium, chloride, and carbon dioxide in the body. Chronic diarrhea may cause these electrolytes to get to abnormally low levels.

Liver Function Tests

Liver function tests (LFTs) measure alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), albumin, total protein, and total and direct bilirubin levels.

Abnormal levels may be caused by malnutrition because the gastrointestinal tract is not absorbing nutrients properly.

Fecal Occult Blood Test

A fecal occult blood test (also called stool guaiac or hemoccult test) is used to examine stool for traces of blood that can not be seen with the naked eye. Stool may also be tested for the presence of a bacterial infection that could cause symptoms.

Imaging

Depending on the symptoms and the suspected cause of the problem, a combination of the following tests may be ordered. The results themselves will be examined to see if they fit with a diagnosis of a form of IBD or a different condition.

X-Rays

X-rays are quick, cheap, and non-invasive. Abdominal x-rays can show if the bowel is narrowed, obstructed, or dilated.

Barium Enema

A barium enema (also called a lower gastrointestinal series) is a special type of x-ray that uses barium sulfate and air to outline the lining of the rectum and colon. The results can show polyps, tumors, or diverticulosis.

Upper GI Series

An upper gastrointestinal (upper GI) series is a type of X-ray used to examine the esophagus, stomach, and duodenum (the first section of the small intestine). Sometimes it is used to examine the small intestine.

Sigmoidoscopy

A sigmoidoscopy is an endoscopic procedure that is used to examine the last third of the large intestine, which includes the rectum and sigmoid colon. This test can be used to check for cancer, abnormal growths (polyps), inflammation, and ulcers.

Colonoscopy

A colonoscopy is an endoscopic procedure used to examine the inside of the colon and can go beyond the areas a sigmoidoscopy can reach. A colonoscopy is useful in detecting colon cancer, ulcers, inflammation, and other problems in the colon. Biopsies can also be taken during a colonoscopy and examined for clues in making a diagnosis.

Upper Endoscopy

An upper endoscopy is used to see inside the esophagus, stomach, and duodenum (first section of the small intestine). It may be used to find the source of swallowing problems, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain.

Differential Diagnosis

Many symptoms of IBD are common in other disorders as well. Other possible diagnoses include:

A Word From Verywell

In some cases, it may take some time to get a diagnosis of IBD. Diagnosis is getting quicker as the tools that are used to diagnose IBD are improving and patients and physicians are becoming more aware of the prevalence of these diseases.

For people who do strongly feel as though IBD is a possibility, seeing an IBD specialist may be the best way to sort out a proper diagnosis. This could mean traveling to see a physician at an IBD center and possibly, paying out-of-pocket. Neither of these things is desirable, but getting the right diagnosis in a timely manner so that treatment can begin is important in the effective management of IBD.

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