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Crohn's Disease Forum » Ask the Experts » How Doctors Detect Inflammatory Bowel Disease


08-13-2013, 08:02 AM   #1
David
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How Doctors Detect Inflammatory Bowel Disease

Rygon recently asked our panel of experts:
What are the ways of detecting IBD and what are you looking for when you do these procedures?
Dr. Marc E. Schaefer, MD, MPH of the Penn State Hershey Inflammatory Bowel Disease Center took time out of his busy schedule to answer this question. A little about Dr. Schaefer:


Marc Schaefer is a board certified pediatric gastroenterologist who has been practicing at Penn State Hershey Children's Hospital since 2009. Dr. Schaefer is active in inflammatory bowel disease clinical research at Penn State Hershey Medical Center, including participation in the Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry, the PROKIIDS Pediatric Inflammatory Bowel Disease Research Network, and ImproveCareNow, which is a health network focused on quality improvement in pediatric inflammatory bowel disease. He also participates in the Hershey Medical Center IBD support group. Dr. Schaefer received his medical degree from Sackler School of Medicine-New York State American Branch. He completed his pediatric residency training at Maimonides Medical Center, Infants and Children's Hospital of Brooklyn and Pediatric Gastroenterology and Nutrition fellowship and Masters in Public Health at Hasbro Children's Hospital/Brown University Medical School.

In regards to the question, Dr. Schaefer stated:

Detecting IBD (inflammatory bowel disease) can range from laboratory tests (blood and stool), radiology tests (imaging tests such as CT, MRI, and small bowel series), capsule endoscopy, and endoscopy with biopsies. The only test that is able to obtain tissue is endoscopy with biopsies (which includes upper endoscopy and colonoscopy) and this is the preferred way of detecting IBD. Laboratory and radiology tests together with seeing the patient to obtain a history and physical exam help a gastroenterologist decide if a person has a greater or lesser likelihood of having IBD. Blood, stool, radiology tests, as well as capsule endoscopy help provide the gastroenterologist with supplemental information about the patient’s IBD, such as disease type (Crohn’s disease or ulcerative colitis), disease severity, and disease location.

Endoscopy with biopsies is the preferred test by gastroenterologists for detecting IBD. It allows us to visualize the digestive tract and obtain tissue (biopsies). We can visualize the esophagus, stomach, duodenum (beginning of the small intestine), terminal ileum (end of the small intestine), and colon. When we visualize the digestive tract, we are looking for loss of the normal healthy features. We are also looking for signs of inflammation (redness, swelling, ulcers, and bleeding). The location and pattern of the inflammation can help the gastroenterologist decide whether a patient is more likely to have Crohn’s disease or ulcerative colitis. Inflammation in the terminal ileum is more likely to be Crohn’s disease. A continuous pattern of inflammation in the colon without inflammation in the terminal ileum is more likely to be ulcerative colitis. In addition, we obtain small pieces of tissue (biopsies) from the internal lining of the digestive tract, especially the areas that look abnormal. These biopsies are reviewed by a pathologist (under a microscope) and provide the gastroenterologist with details about the tissue that help the gastroenterologist make the diagnosis of IBD.

Laboratory tests can provide gastroenterologist with many clues that can raise the suspicion of IBD. A CBC (complete blood count) can tell us if the patient is anemic, as well as suggest the presence of inflammation with a high white blood cell count and high platelet count. ESR (sedimentation rate) and CRP (C-reactive protein) are two ways to screen for and monitor inflammation in the blood. The ESR and CRP do not specifically represent inflammation from IBD and can be elevated due to inflammation not from IBD, such as a viral or bacterial infection. There are also stool tests, such as the stool calprotectin, that measure inflammation. Similar to the ESR and CRP, the inflammation is not specific for IBD. There is a blood test called the “Prometheus IBD Diagnostic” that analyzes different types of proteins in the blood (antibodies, genes, and inflammatory proteins). (1) This test can help the gastroenterologist decide if a patient does have IBD, and in some cases help determine if a patient has Crohn’s disease or ulcerative colitis. The “Prometheus IBD Diagnostic” is not felt to be an accurate enough test to diagnose IBD by itself. There are other blood tests that help monitor a patient’s nutrition status. A poor nutrition status, such as vitamin deficiencies, can be present in patients with IBD.

Radiology tests, such as CT, MRI, and small bowel series, can provide a gastroenterologist with more information about the location of the patient’s IBD. These tests typically require a patient to drink an oral contrast material, such as barium, and then a series of images are taken. These tests can show areas of inflammation in the small intestine and large intestine (colon). Since radiologic tests cannot tell whether the inflammation is from IBD or from a viral or bacterial infection, radiologic tests are not relied on alone to diagnose IBD. These radiologic tests can also find complications of Crohn’s disease, including strictures (areas of intestinal narrowing), fistula (abnormal connections between the intestine and other parts of the body, such as the skin, bladder, or vagina), and abscesses (collections of pus). A fistula with or without an abscess can sometimes be the only finding in a patient that has Crohn’s disease.

Capsule endoscopy is a test that has the patient swallow a tiny wireless camera (a vitamin sized capsule). As the camera travels down the intestinal tract, it takes thousands of pictures that are transmitted to a recorder that a patient wears on their belt or around their shoulder. The test is completed in approximately 8-12 hours or when the capsule appears in the toilet, after a bowel movement. (2) This test is not very common, since most IBD patients can be diagnosed with upper endoscopy and colonoscopy with biopsies. This test is useful when there is the suspicion of inflammation in areas of the small intestine that cannot be reached with conventional upper endoscopy and colonoscopy. The capsule endoscopy can only obtain pictures and cannot provide biopsies. The gastroenterologist reviews the video from the recorder and looks for abnormalities, which in Crohn’s disease, are typically the presence of ulcers.

References
1) http://www.prometheuslabs.com/Resour...uct-Detail.pdf
2) http://www.mayoclinic.com/health/cap...oscopy/MY00139
08-13-2013, 08:40 AM   #2
Tesscorm
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Thanks David and Dr. Schaefer!

David, perhaps this would be a good 'sticky' on the Tests for IBD forum??
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Diagnosed May 2011

Treatment:
May-July 2011 - 6 wks Exclusive EN via NG tube - 2000 ml/night, 1 wk IV Flagyl
July 2011-July 2013 - Supplemental EN via NG, 1000 ml/night, 5 nites/wk, Nexium, 40 mg
Feb. 2013-present - Remicade, 5 mg/kg every 6 wks
Supplements: 1-2 Boost shakes, D3 - 2000 IUs, Krill Oil
08-13-2013, 10:57 AM   #3
nogutsnoglory
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Thank you Dr. for taking your time to weigh in on this question.

I agree with Tess that this would be a good sticky.
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