Learning that you or your loved one has been diagnosed with Crohn's disease or ulcerative colitis may fill you with anxiety, concern, and lots of questions. If there is a reasonable suspicion of inflammatory bowel diseases (IBD), such as Crohn's disease or ulcerative colitis, it is best to seek out a. We are the UK's leading charity in the battle against Crohn's Disease and Ulcerative Colitis and we have dozens of free information sheets, booklets and guides.
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Ulcerative colitis can be controlled with medication and, in severe cases, surgically removing the entire large intestine may be considered as a treatment.
Learn more about ulcerative colitis. Indeterminate colitis is a term used when it is unclear if the inflammation is due to Crohn's disease or ulcerative colitis.
In order to understand Crohn's disease and ulcerative colitis, it is first helpful to understand the anatomy and function of the healthy gastrointestinal GI tract. The functions of the small bowel are to digest your food and absorb the nutrients that are necessary for life.
Many people believe that this is the purpose of the stomach but that is not true. The small bowel particularly the jejunum and ileum is the organ responsible for absorbing nutrients from your food.
Without the small bowel, we would not be able to convert food into useable nutrition. The main functions of the colon are to extract water and salt from stool, and store it until it can be expelled via the anus.
When stool first enters the colon from the small bowel, it is very watery. As it traverses the large bowel, water is reabsorbed and the stool gradually becomes firmer. Let's talk a bit about stool, also known as feces. It may seem glib and a bit crass to kid around about toilet humour and "the scoop on poop". However, the fact of the matter is that bowel function is a normal, absolutely necessary function of the human body. When it is not normal - as with Crohn's or colitis - all kinds of trouble can result.
We, like many who deal with these diseases, address the issues of bowel function and feces in a direct manner, and occasionally with humour, with the best of intent and the desire to help you face this disease openly and frankly. Our aim is to take Crohn's and colitis out of the shadows, where it will remain unless more people talk about it directly.
Stool is the by-product of digestion through the GI tract. In a healthy individual, it is usually composed of water, dead and living bacteria, fiber undigested food , intestinal mucous and sloughed-off lining of the gut. Because the gut has only a limited number of ways to show distress, many of the above symptoms of IBD are non-specific and could also be related to other gastrointestinal conditions.
Ruling out other possible diseases is part of the diagnostic process, starting with patient history and physical examination. A gastroenterologist or pediatric gastroenterologist, if the patient is a child is the most qualified healthcare specialist to diagnose IBD. You will need to provide as much information as possible about your symptoms and when they occur. It helps if you can keep a diary listing your symptoms, including bowel movements, bleeding episodes, waking up at night from pain or diarrhea, fevers, joint aches, or other symptoms.
The diary should include when symptoms started, how often they occur, how long they last, and what makes them better or worse. It also helps to investigate the family tree to identify relatives who may have had IBD or other serious, chronic GI issues. Therefore genetic testing may aid your physician in making appropriate treatment decisions.
Your physician will take your history and perform a physical exam. The physical exam will focus on the GI tract, including inspection of the anus and possibly a rectal examination. These tests fall into several categories. Some are invasive—performed inside the body—while others are non-invasive and require only access to blood or stool samples or radiographic images of the suspected disease site.
Although tests may seem intimidating at first, all are well tolerated by the vast majority of patients. Children will need extra support and coaching, but remember that pediatric specialists routinely perform these tests and can advise you on how to make the process easier for your child.
Physicians commonly use blood tests as part of your diagnostic work-up. Blood tests involve a blood draw, called a venipuncture, from a vein in your arm, although some tests, particularly for pediatrics, may be done from a capillary fingerstick. There are no blood tests that can directly diagnose IBD. However, blood analysis can determine inflammation in the body. Inflammation may be detected through a number of measurements involving blood cells and proteins in the blood or stool.
In addition to being markers of inflammation, blood tests are useful in several other ways. A complete blood count CBC can also show signs of inflammation or infection through an increased white blood cell count. Anemia may be detected through red blood cell measurements. Blood tests may also assess liver and kidney functions, which can be affected by IBD or the medications used to treat the disease.
An electrolyte panel is important to check for dehydration and side effects of medications. Your physician may also order blood tests to predict how well you may respond to a particular medication moving forward.
Blood tests are part of both the initial work-up and ongoing follow-up and monitoring of your condition. They usually do not require any special preparation. The same tests will be required to monitor your disease while in periods of both remission and active disease, or flare-ups. Proteins found in blood and stool, also called biomarkers, may be useful tests for detecting inflammation.
They can help in diagnosis and may predict the course of IBD. The use of some biomarkers is relatively new; they are not used by all physicians.
Stool biomarkers include calprotectin and lactoferrin. Research has shown that these biomarkers are useful in predicting IBD activity, but they are also present in other GI diseases. These blood and stool tests may be more helpful for guiding invasive testing, detecting flares, and optimizing medical therapies than for diagnosing IBD. Gastrointestinal infections with similar symptoms may be identified by testing small stool samples. These tests may look for C.
Specialized tests include serology tests for biomarkers that researchers have associated with IBD. However, these tests will not be necessary for all IBD patients, as in most cases, the physician can make the diagnosis without them. In addition, these biomarkers are not present in a significant number of patients with documented IBD and may also be present in those without IBD.
It is important to realize that many biomarkers are the result of more recent research and have varying degrees of acceptance by the medical community. There are a number of tests that help physicians diagnose and monitor IBD; your physician may not order every one. The perspective is changing based on research and experience. Keep up with current information by speaking with your doctor and checking the CCFA website.
TPMT testing may be ordered when physicians are considering the use of mercaptopurine or azathioprine for patients. Testing can help to determine whether you would be an appropriate candidate for these medications and what the optimal starting dose would be for each person. Specialized blood tests are summarized in the table on page If you have been diagnosed with IBD, even if there are no disease symptoms or extra- intestinal manifestations, you will undergo periodic blood testing for evidence of active inflammation and complications of your disease or medical therapy.
Physicians will tell you that IBD can fool you. You may feel well while inflammation is building in your intestine or other complications are underway.
It is also important to understand that the test results will change over time, reflecting your condition. Tests are a snapshot of where you are today, and not a long-term view of your health.
Tests that your physician may order on a regular basis will include the following:. With a specific disease diagnosis like IBD, health insurance plans will generally cover the cost of monitoring tests as they can contribute to maintaining your health, reducing complications, and finding the right treatments.
Endoscopy is a procedure that lets your doctor look inside your body. Scopes have a tiny camera attached to a long, thin, flexible tube. When you have an endoscopy, your physician will be able to see images of your intestine magnified on a screen during the procedure, allowing him to evaluate different areas of the gastrointestinal tract, to assess the intestinal lining, and to guide biopsies. In the course of performing diagnostic endoscopy, your physician will take multiple biopsy samples of the intestinal lining to evaluate for microscopic inflammation.
Endoscopy also allows the physician to utilize different types of scopes. Colonoscopes, sigmoidoscopes, and endoscopes are all forms of scopes. Although laboratory tests support the diagnosis of IBD, endoscopy plays the most important role. It helps your physician to see if inflammation is present, where it is located, assess its severity, and obtain biopsies to confirm the diagnosis.
Endoscopy is also vital for monitoring your therapy. Healing of the lining of the intestine is a sign that your medication is effective. Given that the colon and end of the small intestine are the most frequently involved in IBD, colonoscopy will be the type of endoscopy most often performed to both diagnose and monitor IBD.
A specially trained physician will guide a colonoscope into your rectum and through the entire length of the colon and end of the small bowel terminal ileum. Typically, you will receive sedation prior to the procedure to minimize discomfort. Many patients sleep through the procedure and do not even recall that the test took place. You should tell your physician if you experience discomfort during the procedure so immediate adjustments to the sedation might be made.
The preparation for a colonoscopy is the greatest challenge you have to face. In order for your physician to see the intestinal lining, it is important to wash out fecal material prior to the procedure. For a colonoscopy, you should expect to:. Before your test, you will typically drink a preparation fluid that purges your colon of stool and debris by causing diarrhea.
Follow the directions from the pharmacy closely. The preparation fluid may have an unpleasant taste. The colon preparation is time-consuming and can be uncomfortable; however, the result will be a clean intestine, with an unobstructed view of the intestinal lining for a successful colonoscopy.
Colonoscopies are generally very safe procedures, but there is an extremely small risk of bowel perforation during the exam. You may want to discuss the risk with the physician performing the test. Your doctor may recommend a colonoscopy to look for any polyps or pre-cancerous changes.
Chromoendoscopy is a technique of spraying a blue liquid dye during the colonoscopy in order to increase the ability of the endoscopist specialist to detect suble changes in the lining of your intestine.
The technique may identify early or flat polyps which can be biopsied or removed. It is common to have blue bowel movements for a short time following this procedure. Other types of endoscopic tests can be ordered to evaluate patients with suspected or established IBD. A pathologist is a physician who will examine biopsy tissue under the microscope for specific features that help make the diagnosis of IBD.
Results from evaluation of biopsies can take as long as one week. Traditional upper endoscopy and colonoscopy will not be able to evaluate about two-thirds of the small intestine. In addition to capsule endoscopy, radiologic exams or diagnostic imaging are performed to evaluate these segments of intestines as well as to evaluate areas outside the bowel. Radiology involves taking pictures that reveal the inside of the body. There are many types of radiological tests used in IBD, including:.
Your physician will order additional tests based on your symptoms and laboratory test results. The Imaging Tests chart on page 18 discusses the areas of interest in the intestine and the radiology and endoscopy tests that you may undergo to confirm the presence of disease at these sites or complications. X-rays are the oldest way of imaging the inside of the body. X-rays are cost-effective and useful for detection of blockages in the small or large intestine. This is called a small bowel obstruction.
The large bowel can also become blocked and dilated. Rarely, people with ulcerative colitis can develop a widening of the large bowel called toxic megacolon. These are serious complications that can be seen on a plain X-ray.
Your healthcare provider will provide specific instructions for preparing for the test. The test exposes you to small amounts of radiation. The contrast used for these tests is usually barium. It is a thick, chalky liquid that can be given by mouth or via the rectum.
There are two types of contrast X-rays of the small intestine: The large bowel X-ray is called a barium enema. When you arrive for the test, you will change into a hospital gown and the technologist will take a plain X-ray or scout film.
For a small bowel follow-through, you will drink several cups of barium and then have an X-ray taken every minutes as the barium travels down the small intestine and enters the large intestine. The time required is variable but may be as long as four to five hours. An enteroclysis is similar, except that the barium is placed directly into the small intestine through a tube in the nose or mouth.
During a barium enema, the barium is placed directly into the colon using a tube inserted into the rectum. During the exam, the colon is distended with air to provide better images. A CAT scan, also known as a CT scan, takes simultaneous X-rays from several different angles to reconstruct a realistic image of the internal organs see Figure 2.
It may involve a contrast material delivered orally, rectally, or intravenously to improve the quality of the test. During the test, you will be on a special table that advances through the scanner to take images at each level of your abdomen. Newer scanners have an open design to minimize claustrophobia. A CT of the abdomen takes five to 20 minutes to complete. The CT scan is used to rule out complications of IBD, such as intra-abdominal abscesses, strictures, small bowel obstructions or blockages, fistulas, and bowel perforation.
In addition, CTE reconstructs images in 3-D to better visualize the small bowel in relation to other organs. The physician may perform this exam to identify areas of inflamed bowel and more subtle obstructions or blockages. This test emits significant amounts of radiation. You may discuss with your physician whether imaging alternatives, such as MRI, are more appropriate for you.
Be aware that some patients are allergic to the contrast agent in intravenous form. Let the technician know if you think you have an allergy. Patients with kidney disease, diabetes, or dehydration are at increased risk for kidney side effects from the intravenous contrast material.
Magnetic resonance imaging MRI is useful for viewing internal organs, muscles, soft tissue, and the brain.
About Crohn’s & Colitis
Crohn's Disease is a condition that causes inflammation of the digestive system or gut. It's one of the two main forms of Inflammatory Bowel Disease (IBD). Pictures help explain Crohn's and ulcerative colitis, including the symptoms, causes, testing, treatments, and home care needed to manage. Crohn's disease and ulcerative colitis can be easily confused. WebMD explains how these inflammatory bowel diseases are alike and what.