What are the methods for screening for Inflammatory Bowel Disease (IBD)?

From the Guidelines

Screening for inflammatory bowel disease (IBD) should involve a combination of clinical evaluation, laboratory tests, imaging, and endoscopic procedures, with a focus on non-invasive and radiation-free methods like intestinal ultrasound (IUS) as suggested by the most recent study 1. When screening for IBD, healthcare providers should initially assess for symptoms like chronic diarrhea, abdominal pain, rectal bleeding, weight loss, and fatigue.

• Blood tests including complete blood count to check for anemia, C-reactive protein and erythrocyte sedimentation rate to detect inflammation, and comprehensive metabolic panel to assess liver and kidney function are recommended.
• Stool tests should be performed to rule out infectious causes and measure fecal calprotectin and lactoferrin, which are elevated in IBD.
• Definitive diagnosis requires colonoscopy with biopsies, which allows direct visualization of the intestinal mucosa and collection of tissue samples for histological examination, as outlined in the guidelines for the management of IBD 1. Upper endoscopy may be needed if upper GI symptoms are present.
• Imaging studies like CT enterography or MR enterography help evaluate the small intestine, which may not be fully accessible by endoscopy.
• Genetic testing and serological markers (ASCA, p-ANCA) can provide additional diagnostic information in certain cases, as noted in the european consensus on the histopathology of inflammatory bowel disease 1. Early screening is crucial as prompt diagnosis and treatment of IBD can prevent complications like strictures, fistulas, and reduce the risk of colorectal cancer in long-standing disease. The use of IUS has emerged as a valuable tool for objectively assessing and monitoring IBD activity, offering a non-invasive, radiation-free alternative to endoscopies and biomarkers, as discussed in the aga clinical practice update on the role of intestinal ultrasound in inflammatory bowel disease 1. Optimizing reporting for cross-sectional imaging in IBD is essential for effective communication between specialists and to improve patient care, as highlighted in the ecco-esgar topical review on optimizing reporting for cross-sectional imaging in inflammatory bowel disease 1.

From the Research

Screening Methods for Inflammatory Bowel Disease

To screen for inflammatory bowel disease (IBD), several methods can be employed, including:

• Endoscopic evaluation: A full colonoscopy and ileoscopy should be performed when possible, with systematic biopsies from each segment, as stated in the study 2.
• Blood parameters: Routine blood parameters such as serum C-reactive protein (CRP) level, serum erythrocyte sedimentation rate (ESR) level, total white blood cell (WBC) count, eosinophil (EOS) count, and platelet (PLT) count can be used to predict complications in IBD patients 3.
• Biomarkers: Biomarkers such as CRP, ESR, fecal calprotectin, and fecal lactoferrin can be used to distinguish between patients with IBS and IBD, and healthy controls 4.

Blood Parameters for Screening

Blood parameters can be used to screen for IBD, including:

• CRP level: A higher serum CRP level can indicate a higher hazard for the earlier occurrence of pseudopolyp formation in UC patients 3.
• ESR level: A higher serum ESR level can predict the development of fistulas in CD patients, and strictures in CD patients 3.
• WBC count: A higher total WBC count can indicate a higher hazard for the earlier occurrence of pseudopolyp formation in UC patients 3.
• EOS count: A lower eosinophil count can predict the development of fistulas in CD patients 3.
• PLT count: A higher PLT count can predict the development of strictures in CD patients 3.

Biomarkers for Screening

Biomarkers can be used to screen for IBD, including:

• CRP/ALB ratio: The CRP/ALB ratio can be used to evaluate disease activity in IBD patients, with a higher ratio indicating higher disease activity 5.
• Fecal calprotectin: A fecal calprotectin level of ≤40 μg/g can essentially exclude IBD in patients with IBS symptoms 4.
• Fecal lactoferrin: Fecal lactoferrin can be used to distinguish between patients with IBS and IBD, and healthy controls, although its clinical utility is limited 4.