How Inflammatory Bowel Disease (IBD) Is Diagnosed

Inflammatory bowel disease (IBD) is diagnosed by evaluating gastrointestinal symptoms, blood work, diagnostic imaging, and ruling out other conditions.

Accurately diagnosing inflammatory bowel disease (IBD) can be challenging and take some time. Its symptoms, such as abdominal pain and diarrhea, can mimic those of other gastrointestinal conditions.

If you're experiencing gastrointestinal issues consistent with IBD, see your healthcare provider for an evaluation. Getting the right diagnosis as soon as possible can help you start proper treatment so you can start feeling better.

Self-Monitoring

You can't conduct any at-home tests to confirm IBD. However, keeping a detailed diary of symptoms can be useful to your healthcare provider and helpful in identifying patterns that may hint at a diagnosis.

The first clues are often the following IBD symptoms:

• Unrelenting diarrhea
• Blood and/or mucus in the stool (more common with ulcerative colitis than Crohn’s disease)
• Fever
• Abdominal pain

Also log instances of other gastrointestinal symptoms, such as:

• Vomiting
• Fatigue
• Headaches
• Weight loss

Bring your notes to your medical appointment. Reviewing them may prompt your healthcare provider to refer you to a gastroenterologist, a physician who specializes in the digestive tract.

Labs and Tests

Your healthcare provider 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.

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

• 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 type 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

Some conditions are commonly mistaken for IBD and some of the classic symptoms of IBD are vague, so your healthcare provider will not immediately determine IBD is the diagnosis.

Other medical conditions they will consider and work to rule out include:

• Parasitic infection
• Irritable bowel syndrome
• Diverticulitis
• Celiac disease
• Colon cancer
  

Treatment

Although there is no cure for IBD, it’s possible to reduce inflammation and reduce symptoms. IBD treatment varies depending on the specific condition but may include:

• Aminosalicylates: to reduce inflammation in the digestive tract
• Biologics: medications made from living sources (human, animal, or microorganisms) that block the immune system chemicals that trigger inflammation
• Corticosteroids: to quickly reduce inflammation
• Immunomodulators: to reduce intestinal inflammation and manage flare-ups by blocking the immune response
• Non-steroidal anti-inflammatory medications (NSAIDS): to reduce pain and inflammation
• Antidiarrheal medications: suppositories or enema preparations that can help reduce diarrhea and fecal incontinence
• Antibiotics: used when an infection is a concern

As a last treatment option when medication is no longer helping, surgical treatment may be considered to remove diseased sections of the bowel or colon.

Summary

IBD is diagnosed by evaluating gastrointestinal symptoms, blood work, diagnostic imaging, and ruling out other conditions. Although the process can take time, getting the right diagnosis is important for starting effective treatment.