There are many symptoms that accompany inflammatory bowel disease and these can leave the sufferer reeling and confused. Not to mention all the tests and blood work and various things that doctors can put you through. There are a lot of life alternating things that happen when someone starts to develop one of these diseases but there are only a few tests that doctors typically do to test for inflammatory bowel disease. In this blog post I will discuss these diagnostic tools and what you can expect if you are about to go through them or have a loved one that you are helping through the process.
One of the main diagnostic tools that practitioners will use when diagnosing inflammatory bowel disease is called a colonoscopy. This test is used to visualize the inside of the anus, rectum, large bowel (colon) and some of the last parts of the small bowel. The doctor will use a scope which is inserted through the anus and rectum to see the inside of all these areas. Sedation is used to provide comfort (and a good nap). The doctor can take tissue samples during this procedure in order to biopsy the areas that look questionable. The whole procedure usually only last about 20-30 minutes and is done in the out patient setting.
The colonoscopy itself is a breeze compared to the preparation for the procedure! Your doctor will ask you to ‘prep’ for the colonoscopy by cleansing the bowels. This means that you will be drinking a solution of laxatives with some kind of electrolyte drink as well as taking some laxative pills in order to clean out the bowels. The day before your procedure you will not be able to eat anything solid and will be limited to certain clear liquids that are not colored purple blue or red. The night before the procedure, depending on your specific procedure time, you will begin to drink the laxative solution, take your pills and then wait for them to do their jobs. Usually within a few hours you will be running back and forth to the bathroom and then all throughout the night after. Once your stool is clear or yellowish clear this is a good sign that things are all cleared out in the bowels.
If the doctor takes biopsies during the procedure you will get the results in a few days.
One of the ‘tell tale’ signs of Crohn’s disease is shown in the biopsies that have granulomas or inflammatory cells. A granuloma is a group of cells that are found in the presence of infection or inflammation. If there are granulomas present (like in my case, yay!) you will more than likely get the inflammatory bowel disease diagnosis immediately. The biopsies will also be checking for cancerous cells and various other things to help the diagnosis along but often granulomas are a positive indication of Crohn’s disease.
After the colonoscopy you will feel gassy, tired and bloated. As you start to eat solid foods and the laxative effects wear off you will feel better and get your strength back. I have had several colonoscopies and they are not that bad. I have learned when to start and stop drinking my solutions so that I am cleaned out but not overly dehydrated. I have learned that eating smaller meals in the days leading up to a coloscopy can really help the preparation for one. Also, limiting fiber and nuts and seed prior to the prep is also extremely helpful. No one wants to go through a colonoscopy but it is the best way to get a look at what is going on inside if you are having symptoms.
Another test that is often done with the colonoscopy is the upper endoscopy. This test is usually done in conjunction with the colonoscopy. Doing both exams during the same procedure time of sedation is easier for everyone involved and gives a pretty clear view of almost the entire digestive tract. There will be areas of the small bowel that can not be seen with these scopes because the small bowel is really long and neither scope can fit throughout the whole thing. The upper endoscopy will visualize the mouth, esophagus, diaphragm, stomach, duodenum, jejunum and the beginning parts of the small bowel. Biopsies can be taken from any of those sites as well and evaluated for changes suggesting Crohn’s or any other problems. If you are only having the upper endoscopy you will not need to bowel cleanse as you do for a colonoscopy. You will have to fast for 12+ hours and sometimes it is required to cleanse the bowel on a smaller scale. The recovery is the same and usually very easy on the patient.
Sometimes there is the need to visualize the entire small bowel. When this is the case the provider will order a capsule swallow. This is when the patient will swallow a pill sized camera which will take pictures of the inside of the digestive tract all the way through from the mouth to the anus. The capsule is excreted in the stool during the next bowel movement and the pictures are automatically sent to the provider via website. As long as you are ok swallowing a large pill this test is a breeze. You will have to fast for it and after as the pill camera is going through your system for a few hours, but it doesn’t get much worse than that and it does give your doctor a pretty good picture of what is going on inside. Scopes are a better way to visualize as you can control them better and the doctor is standing right there watching everything but pills swallows are becoming more and more popular as they are minimally invasive and no sedation is necessary.
However, with the pill capsule study you are unable to biopsy so a scope may be necessary after this test. Or this test may not be done until after a scope is done to verify remission or active diesease after the scope has already been done.
There are other tests done for Crohn’s disease as well. Although these tests are usually reserved for after the the scopes are done and the patient has been diagnosed. Sometimes they are done before diagnosis for patients that may not have clear cut symptoms of inflammatory bowel disease or adamantly do not want a scope preformed. These are the MRI tests and the cat scans and tests similar that they will often use to see inflammation or any fistulas or soft tissue damage.
One of these kinds of tests could require barium to be drank prior to the test. This is a substance that will light up during the scan and show the inside of the bowel better on the images. The barium is, I’m not gonna lie, NASTY. It is a chalky gross milk-shake type drink that I gag on every time. I have vomited it up several times and when I had my bowel obstruction had to drink it again and it was AWFUL. I have heard rumors that most hospitals are turning to a new kind of barium that is not chalky and the patient has to drink less liquid with it. Hopefully this is true.
Of course there are also the blood tests to test for inflammation and infection and the stool tests to check for parasites and inflammation or infection. These are all great diagnostics tools, but the most accurate and the one that everyone suspected of IBD must have are the scopes! Just remember that it is only temporary and it will allow the provider to see what is going on. They really aren’t all that bad. And after the first one, you will be a pro!
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