How Inflammatory Bowel Disease Is Diagnosed

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Accurately diagnosing inflammatory bowel disease (IBD) can be challenging. Its symptoms, such as abdominal pain and diarrhea, can mimic those of other gastric conditions, which must first be ruled out before reaching an IBD diagnosis. A patient history, bloodwork, and diagnostic imaging may all be used to aid in this process.

Tests are also used to distinguish between the different forms of IBD: Crohn’s disease, and ulcerative colitis.

All of this can take some time. As such, it's important to see your doctor as soon as possible for an evaluation if you're experiencing gastrointestinal issues consistent with IBD. Getting the right diagnosis as soon as possible can help you start proper treatment so you can start feeling better.

For severe symptoms (e.g., significant abdominal pain, substantial bleeding), seek immediate medical attention.

Self-Checks

You can't conduct any at-home testing that will confirm IBD. But keeping a detailed diary of symptoms can be useful to your doctor and helpful in identifying patterns that may hint at a diagnosis.

The first clues are often the following symptoms, so be sure to note:

Also log instances of other gastrointestinal symptoms, such as:

  • Vomiting
  • Fatigue
  • Headaches
  • Weight loss

Bring your notes to your doctor's appointment. Reviewing them may prompt your doctor to refer you to a gastroenterologist, a physician who specializes in the digestive tract.

Labs and Tests

Your doctor will decide the right tests for you based on your medical history, family history, and symptoms. Tests will be done to rule out other illnesses, but may also be done to test for conditions that sometimes occur along with IBD, such as arthritis.

Complete Blood Count (CBC)

A CBC includes 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.

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.

Electrolyte Panel

An electrolyte panel measures levels 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 stemming from the gastrointestinal tract not absorbing nutrients properly.

Imaging and Procedures

Depending on the symptoms and the suspected cause of the problem, a combination of the following studies may be ordered. The results 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, relatively inexpensive, 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). It is sometimes used to examine more of 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 in a lab for additional clues.

Upper Endoscopy

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

Differential Diagnoses

Given that some of the classic symptoms of IBD are, generally speaking, vague, your doctor will not immediately jump to a conclusion of IBD. Among the other concerns that they will consider and work to rule out are:

A Word From Verywell

Seeing an IBD specialist may be the best way to go if you feel strongly about your symptoms but have not yet gotten a diagnosis. For some, this could mean traveling to see a physician at an IBD center and, possibly, paying out-of-pocket. Neither of these things is desirable or, in some cases, possible. But getting the right diagnosis in a timely manner so that treatment can begin is important in the effective management of IBD. At the very least, consider seeking a local second opinion.

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