Diagnosing IBD

When the words “Inflammatory Bowel Disease”, “Crohn’s”, or “Ulcerative Colitis” are mentioned for the first time in a doctor’s office, confusion can take over. What does this mean for you and your body? What tests are going to be done to make sure your diagnosis is accurate? In this post, I am going to talk about many (definitely not all) of the tests that can be done when IBD is suspected. This list may seem overwhelming, so please take your journey one day at a time!

X-Ray   One of the first and most simple tests that can be done is an x-ray. It can give enough information to your doctor to let them know you are safe. It can show critical issues like obstructions or strictures, and this let’s them know what steps to take next. You have probably had an x-ray at some point in your life, whether you have broken your arm or you had a funky PPD result. It’s just as straight forward when they do an abdominal x-ray. No prep required!

CT (Computed Tomography)   This test is another one used to look for complications. It can show abscesses or fistulas. It is basically an x-ray image but the imaging device rotates around you. The pictures are more detailed because they show “cross-sections” instead of just a 2-D image like a regular xray would. Oral or IV contrast may be used during this exam to help see soft tissue. X-rays are good at seeing our bones, but to see our squishy intestines, it needs a little help!

Upper GI   This test requires a series of x-rays and for you to drink a barium solution. The solution often tastes like a very chalky milkshake. They will take images as you drink the solution (imagine lying down, head to the side, sipping from a straw), as it goes down your esophagus and into your stomach. They may also follow it into the small intestine – it depends on what your doctor wants to see. It may take only a couple of hours, or it may take longer. In my case, prior to the removal of my strictures, it took six hours for the barium to pass through!

Barium Enema   This is sort of similar to an Upper GI, but instead of drinking the solution, it is inserted via an enema. It is not the most dignifying procedure. I remember finishing my barium enema and running to the bathroom, barium pouring out of me because I couldn’t hold it in! Do not be ashamed if this happens to you, the radiology techs are used to this and even expect it.

Colonoscopy   You probably have heard of this before. If you are having digestive issues, then this will most likely be ordered. It requires a flexible tube-like camera to be inserted through the anus to take images/video of the colon. You can be sedated or it can be done while awake. The test also requires your colon to be clear, so you may have heard of terms like “prep” or a “clean-out”. This sometimes involves a large dose of laxatives like Miralax or Go-Lytely. They may also ask you to do enemas to clear the last part of the colon if you are struggling to get your stools clear. The goal is to have yellowy, watery stools. It can be a rough couple of days, will lots of running to the bathroom and not being able to eat for 24-48 hours, but you want your test to be done to the best of its ability!

Flexible Sigmoidoscopy   This is pretty much a colonoscopy, but instead of viewing the whole colon, it views the sigmoid (last part of colon). Often it is called a “flex sig”.

Endoscopy   This test is similar to the previous two, but the camera passes through the mouth to view the esophagus, stomach, and duodenum. Often patients complain of a slightly sore throat afterwards, but something like chloraseptic spray or ice chips can help ease this pain.

Pillcam   This is exactly what it sounds like – a camera in the shape of a pill! It is actually a very cool piece of technology. The pill is swallowed, and it takes pictures (just like an endoscopy) as it passes through the GI tract. A receiver is worn around the waist and the images taken are collected through this. It doesn’t require sedation and the recovery time is instant.

MRE (Magnetic Resonance Enterography)   This procedure allows for detailed images of the bowels using IV and oral contrast. You usually do have to drink a decent amount of the contrast, which can be difficult to do. If it cannot be done, an NG can be placed to help complete the contrast drink.


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