From the Guidelines
The workup for inflammatory bowel disease (IBD) should follow a stepwise approach to rule out ongoing inflammatory activity, including measurement of fecal calprotectin, endoscopy with biopsy, and cross-sectional imaging. This approach is recommended by the most recent and highest quality study 1. The initial step in the workup involves clinical assessment and laboratory tests, including complete blood count, comprehensive metabolic panel, inflammatory markers, and fecal calprotectin to detect intestinal inflammation.
Key Components of IBD Workup
- Measurement of fecal calprotectin to detect intestinal inflammation
- Endoscopy with biopsy for direct visualization and histopathological confirmation
- Cross-sectional imaging, such as CT enterography or MR enterography, to assess small bowel involvement and identify complications
- Consideration of alternative pathophysiologic mechanisms, such as small intestinal bacterial overgrowth, bile acid diarrhea, carbohydrate intolerance, and chronic pancreatitis, based on predominant symptom patterns
Additional Considerations
- Stool studies to rule out infectious causes that can mimic IBD
- Serologic markers, like anti-Saccharomyces cerevisiae antibodies (ASCA) and perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA), to help differentiate between Crohn's disease and ulcerative colitis
- Capsule endoscopy may be considered when small bowel Crohn's disease is suspected but not confirmed by other methods
- Optimized reporting for cross-sectional imaging in IBD is crucial for effective communication between specialists and to improve patient care, as emphasized in a recent topical review 1
Management of Functional GI Symptoms
- A low FODMAP diet may be offered for management of functional GI symptoms in IBD, with careful attention to nutritional adequacy
- Psychological therapies, such as cognitive behavioral therapy, hypnotherapy, and mindfulness therapy, should be considered in IBD patients with functional symptoms, as recommended by the AGA clinical practice update 1
From the Research
Workup for Inflammatory Bowel Disease (IBD)
The workup for IBD involves a combination of clinical evaluation, laboratory tests, and imaging studies. Some key points to consider include:
- There is no single test available to confidently diagnose cases of IBD 2
- Physicians rely on a number of diagnostic tools, including clinical evaluation, serum testing, and imaging, which are used in conjunction with endoscopic evaluation 2
- Laboratory tests such as C-reactive protein, erythrocyte sedimentation rate, and fecal calprotectin can be used to aid in the diagnosis of IBD 2, 3
- Colonoscopy is an important diagnostic tool for IBD, but it is not without risks, including perforation 4
- Serum biomarkers, such as cytokines, antibodies, and non-coding RNAs, are being researched as potential tools for diagnosing and monitoring IBD 3
Diagnostic Tools
Some of the diagnostic tools used in the workup for IBD include:
- Clinical evaluation: a thorough medical history and physical examination are essential in diagnosing IBD 2
- Laboratory tests: such as complete blood count, electrolytes, and liver function tests 5
- Imaging studies: such as X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans 2
- Endoscopy: colonoscopy and upper endoscopy can be used to visualize the inside of the bowel and take tissue samples for biopsy 2, 4
- Biomarkers: such as C-reactive protein, erythrocyte sedimentation rate, and fecal calprotectin can be used to aid in the diagnosis of IBD 2, 3
Importance of Workup
A thorough workup is essential in diagnosing and managing IBD. It can help: