Based on a careful history of symptoms, the examining physician will be able to distinguish between Crohn’s disease and ulcerative colitis. But diagnosis can be troublesome because other diseases have IBS like symptoms. For example, Crohn’s disease is commonly misdiagnosed as celiac disease, or diverticulitis. This is because it can affect various regions of the gastrointestinal tract. Physicians accordingly use additional tests such as:
Barium enema before x rays. In this test, also called a ‘‘lower gastrointestinal (GI) series’’, an enema tube is inserted into the patient’s rectum and a barium solution is allowed to flow in to improve the contrast of the x rays.
Colonoscopy. Test that allows the physician to look inside the colon using a colonoscope, a long, flexible tube that has a miniaturized color-TV camera at one end. It is inserted through the rectum into the colon, and provides a view of the lining of the lower digestive tract on a television monitor.
Complete blood count (CBC) test. This test measures the number of red and white blood cells, the amount of hemoglobin in the blood, the fraction of the blood composed of red blood cells (hematocrit), and the size of the red blood cells.
C-reactive protein (CRP). CRP is a test that measures the amount of a protein in the blood that signals acute inflammation.
Endoscopic ultrasound (EUS). Technique that uses sound waves to create a picture of the inside of the body. It uses a special endoscope that has an ultrasound device at the tip. It is placed in the gastrointestinal tract, close to the area of interest.
Esophagogastroduodenoscopy (EGD). EGD is a technique used to look inside the esophagus, stomach, and duodenum. It uses an endoscope to investigate swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain.
Flexible sigmoidoscopy. Technique that allows to look at the inside of the large intestine from the rectum through the last part of the colon, called the sigmoid colon.
Sedimentation rate (ESR). This test draws blood from a vein, usually from the inside of the elbow or the back of the hand. It measures the distance that red blood cells settle in unclotted blood toward the bottom of a specially marked test tube.
Stool guaiac. This test finds hidden (occult) blood in the stool.
Controlling Infalammation is the primary Goal of Treatment for IBD
The primary goal of treatment is to control inflammation and reduce the symptoms of pain, diarrhea, and bleeding when present. Many types of medicine can reduce inflammation, including antiinflammatory drugs such as sulfasalazine (Azulfidine), corticosteroids such as prednisone, and immune system suppressors such as azathioprine (Imuran) and mercaptopurine (Purinethol). An antibiotic, such as metronidazole (Flagyl), may also be helpful for destroying germs in the intestines, especially for Crohn’s disease. Anti-diarrheal medication, laxatives, and pain relievers may also be prescribed. If symptoms are severe, such as diarrhea, fever or vomiting, hospitalization may be required to administer intravenous fluids and medicines.
In the case of severe ulcerative colitis that can not be helped by medications, a type of surgery called bowel resection may be performed to remove a damaged part of the intestine or to drain an abscess. If a part of the bowel is removed, a procedure is done to connect the remaining two ends of the bowel (anastomosis). In very severe cases, removal of the entire large intestine (colectomy) is required. Bowel resections may also be performed for Crohn’s disease patients.
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