Diagnosing IBD

There is no gold standard for diagnosing IBD.[1]


Diagnosing IBD is based on clinical assessment and requires the use of multiple diagnostic tools (for example, physical examination, endoscopy, colonoscopy, X-Rays, CT-scans, tissue biopsies), because IBD has many signs and symptoms. No single test can be used to accurately diagnoses IBD.


Below are the common tests and methods used to diagnose IBD:


Clinical History: The doctor or their staff will develop a detailed medical record of your past and current medical history.


Physical Examination: A physical exam is used to check your overall health and to assess any medical problems.


Laboratory Tests: Multiple tests, such as blood work are ordered. Indicators may be recognized in bloodwork that point to IBD.


Endoscopy: Is a procedure where a flexible tube (endoscope) is inserted down your throat and into the stomach.  A tiny camera on the end of the endoscope allows your doctor to see what’s going on in your stomach and beginning of your small intestine.  They may take a sample of the tissue inside the stomach, which is sent to a lab for analysis.


Colonoscopy: Similar to an endoscopy, it is a procedure when a camera is inserted into the colon, allowing the doctor to see inside the intestines.  They may take a sample of the tissue inside the colon, which is sent to a lab for analysis.


Barium X-Rays: A barium X-ray is a radiographic (X-ray) examination of the gastrointestinal (GI) tract. Barium X-rays (also called upper and lower GI series) are used to diagnose abnormalities of the GI tract, such as tumors, ulcers and other inflammatory conditions, polyps, hernias, and strictures. The use of barium with standard X-rays contributes to the visibility of various characteristics of the GI tract. Barium is a dry, white, chalky powder that is mixed with water to make barium liquid. Barium is an X-ray absorber and appears white on X-ray film. When instilled into the GI tract, barium coats the inside wall of the esophagus, stomach, large intestine, and/or small intestine so that the inside wall lining, size, shape, contour, and patency (openness) are visible on X-ray.[2]


CT or CAT Scans: A computed axial tomography scan may be ordered to get a different view of your gastrointestinal tract.  Similar to CT scans, you will need to drink a type of barium that is used to coat the esophagus, stomach, or intestine and is not absorbed into the body.  This allows your doctor to see clearly the diseased or damaged areas.


MRI: Magnetic resonance imaging (MRI) uses a magnetic field, which helps doctors see organs inside the body, enabling them to see indicators of IBD.


Tissue Biopsies: A tiny piece of tissue is taken from the gastrointestinal system and sent to a pathologist.  The pathologist looks at the tissue under the microscope, looking for inflammation and other indicators of IBD.

[1]Baugart DC. The diagnosis and treatment of Crohn’s disease and ulcerative colitis. Dtsch Arztebl Int, 2009;106:123-133.]

[2] https://www.hopkinsmedicine.org/healthlibrary/conditions/radiology/barium_x-rays_upper_and_lower_gi_85,P01275 Accessed Oct 30th, 2017