How Is Inflammatory Bowel Disease (IBD) Diagnosed?
DiagnosisInflammatory bowel disease can be diagnosed using an array of different methods and tests.
Physical exams and medical history reviews will be done to check for symptoms such as swelling, increased heart rate, and other issues. The doctor will ask you about any family history of IBD, as well as your diet, lifestyle, and any other conditions you may have to understand your overall health better.
Blood and stool tests
Samples of blood or stool, or both, may be taken to look for certain proteins, called biomarkers, that can help detect inflammation; if detected, further tests can be done to determine the location of the inflammation and inform what other testing may be needed.
Endoscopies
After reviewing stool and blood test results, doctors may perform an endoscopy to look inside the GI tract. Some of the most common types of endoscopies for IBD include:
- Colonoscopy — Doctors may perform this common procedure in order to examine the colon (part of the large intestine). This is done by inserting a thin, flexible, and lighted tube through the anus, extending through to the entire colon. Sedation is typically provided to minimize any discomfort.
- Sigmoidoscopy — This procedure is done to specifically examine the left side of the rectum or colon, via a flexible, lighted tube inserted through the anus. Often used to confirm ulcerative colitis (UC) diagnosis, this procedure is quick and typically causes less discomfort than a colonoscopy, meaning it can usually be done without sedation.
- Upper GI endoscopy — During an upper GI endoscopy, a thin, flexible, and lighted tube is inserted through the mouth, down through the esophagus and into the stomach, reaching as far as the duodenum, the first part of your small intestine (also called the small bowel). This is used for people suspected of or diagnosed with Crohn’s disease to better assess symptoms.
- Video capsule endoscopy — This type of endoscopy is done by swallowing a small, pill-sized camera. This camera takes pictures of the small intestine and bowel. The pictures are stored in a recorder worn by the patient around the waist then reviewed by the doctor. The camera is passed in the stool.
Imaging tests
Various imaging tests may be performed to better view certain areas of the small intestine that cannot be reached during endoscopies. Imaging may include:
- X-ray — This common imaging test uses electromagnetic radiation to create images of the inside of the body. This can help doctors see whether there are blockages or obstructions in the digestive tract.
- Barium contrast study — Barium contrast studies involve ingesting barium, a material that creates contrast inside the body, allowing better images to be taken. Different kinds of studies can be conducted to view specific areas of the digestive tract. These studies include upper GI series, lower GI series, small bowel series, and small bowel enteroclysis, which involves placing barium directly into the small intestine via a small tube that is inserted through the mouth or nose.
- Cross-section imaging — Cross-sectional imaging encompasses computed tomography (CT) and magnetic resonance imaging (MRI) scans. This kind of imaging is useful in assessing the thickness of the bowel wall and detecting inflammation, fistulas, abscesses, and obstructions.
Biopsy
A biopsy involves removing a small sample of tissue from the digestive tract and may be done during an endoscopy. The sample will then be assessed for features that may support an IBD diagnosis. This procedure is virtually pain-free.
How Is IBD Treated?
TreatmentThere is no cure for IBD, but the proper treatment can significantly reduce symptoms, allowing for periods of remission, in which the disease is inactive. IBD can be treated in several different ways depending on the specific diagnosis (Crohn’s disease, ulcerative colitis, or microscopic colitis) and the severity of the disease.
Both surgical and nonsurgical IBD treatments are available:
Medication
- Anti-inflammatory drugs may be prescribed to reduce inflammation and relieve pain. This is a common course of treatment for mild to moderate cases of ulcerative colitis. Courses of corticosteroids — immunosuppressing drugs that can calm overactive immune responses and reduce inflammation — are sometimes used to induce remission. Other types of immune system suppressors may also be used. These suppress the body’s overactive immune responses that cause inflammation.
- Biologics are a newer therapy used to neutralize the proteins in the body that are causing inflammation. Biologics may be administered through intravenous (IV) infusions or self-injections you can do at home.
- Antibiotics are prescribed in cases in which infection is a concern. Some cases of Crohn’s, for example, may begin after an infection. Additionally, certain vitamins, supplements, pain relievers, and antidiarrheal medicines may be prescribed to relieve symptoms and help your body better absorb certain nutrients.
- Infusion therapies may be recommended in some IBD cases. Infusions may include stem cell infusion therapy to alleviate inflammation, medications for controlling chronic pain, iron infusions for IBD-associated anemia, and intravenous hydration and nutrition therapy.
Dietary changes
People with IBD may find that certain foods and beverages — such as wheat, sugar, dairy, and alcohol — make their symptoms worse. When you have IBD, it’s important to make sure you get enough nutrients to support your health. Working with your gastroenterologist, a registered dietitian can help you identify foods you should avoid and make sure that you are eating and absorbing enough food to meet your nutritional needs.
Lifestyle changes
Some people with IBD find that relieving stress or stopping cigarette smoking helps ease symptoms. Engaging in relaxing activities like yoga, meditation, reading, and walking can help reduce stress. Some people see a therapist to talk about the symptoms and learn how to better manage the mental effects of IBD. Psychiatrists can also prescribe certain medications to reduce anxiety and stress.
Surgical treatment
If dietary changes, lifestyle changes, and medications are not enough to control symptoms, surgery for IBD may be necessary. Minimally invasive laparoscopy is often used for some types of IBD surgery. This method uses small incisions to allow for less discomfort after surgery and a speedier recovery than open abdominal surgery.
At NewYork-Presbyterian (NYP), our colorectal surgeons have pioneered several IBD surgical approaches used today, offering resection to remove diseased intestinal tissue and strictureplasty to open up intestines narrowed by scar tissue. If needed in very severe cases, we also offer colectomy to remove some or all of the colon and proctocolectomy to remove the rectum. Explore these surgeries and others often used for IBD:
Small bowel resection
A small bowel resection involves the removal of damaged parts of the small intestine. In most cases, there is enough healthy intestine remaining, which means the free ends of the small intestine can be connected.
If there is not enough healthy intestine remaining, an ileostomy will be performed, in which the small intestine is diverted through a small opening in the lower right abdomen, called a stoma. This allows stool to divert into an ostomy bag that is placed outside the abdomen. This bag lies fairly flat underneath clothing, and patients can continue their normal activities after recovery. Your medical team will help you adjust to this life change.
Intestinal strictureplasty
In some cases of IBD, scar tissue can build up and block part of the intestinal tract, or severe inflammation in the GI tract can narrow the small intestine, blocking digested food from passing through. To address this, an intestinal strictureplasty may be performed to widen the area and restore bowel function.
No intestinal tissue is removed during a strictureplasty, and there are several different approaches to the surgery. Your doctor will recommend a specific approach based on the results of your diagnostic imaging tests.
Colectomy
During a colectomy, some or all of the colon (part of the large intestine) is removed. This may be done for severe cases of Crohn’s disease or ulcerative colitis, based on the results of diagnostic imaging and tests, and whether medication has failed to relieve inflammation. In cases of ulcerative colitis limited to the colon, a colectomy can serve as a cure for the disease.
Proctocolectomy
If inflammation has spread to the rectum, a proctocolectomy may be performed to remove the rectum as well as the colon. There are different variations of this surgery based on the type of IBD.
- Proctocolectomy with end ileostomy — Patients with Crohn’s disease requiring a proctocolectomy usually have a proctocolectomy with end ileostomy, in which the end of the small intestine is inverted through a small hole created in the abdominal wall, called a stoma, that allows stool to divert into an ostomy bag. This is placed externally on the lower right abdomen and lays fairly flat underneath clothing. Patients can continue their normal activities after recovery, and your medical team will help you adjust to this life change.
- Ileal pouch anal-anastomosis — Patients with ulcerative colitis requiring a proctocolectomy often have the option of ileal pouch surgery, also called J-pouch surgery. During this surgery, an internal pouch is created to which waste can divert. This is not typically recommended for patients with Crohn’s disease, as the disease can recur inside the pouch.
Clinical trials for IBD
Clinical trials of cutting-edge IBD treatments may also be available to some patients. At NYP, we regularly conduct clinical trials to assess innovative therapies for IBD. If you are interested in learning more about current trials at NewYork-Presbyterian and other facilities across the nation, visit our Clinical Trials page.
Trust NewYork-Presbyterian for IBD Treatment
NewYork-Presbyterian is dedicated to improving the lives of our patients with IBD. Offering comprehensive diagnostic testing and treatment options, we’ll work with you toward a treatment that alleviates your symptoms and betters your quality of life.
If you think you may be experiencing symptoms of IBD, it’s important to seek medical care as soon as possible. Reach out to the team at NewYork-Presbyterian to make an appointment today.