With only a standard yearly physical exam, Crohn's disease can be difficult to identify and evaluate. At first, the only symptoms you might get are joint pain, low-grade fever, anemia accompanied with diarrhea, nausea or abdominal pain. However, there are people who are diagnosed with the disease when they are in severe pain in the ER. Crohn's disease tests include a combination of stool studies, blood tests, endoscopic procedures and radiological imaging tests that help in the identification of Crohn's disease, evaluation of the patients as well as the assessment of disease activity.
Tests and Diagnosis of Crohn's Disease
1. Physical Exam
One of Crohn's disease tests is a physical exam where the doctor will enquire about your medical history and your symptoms. A series of tests may also be carried out to check the state of your general health. The doctor can check your blood pressure, pulse, weight and height, abdomen and temperature.
2. Blood Tests
Your doctor can have your blood drawn and sent to the lab for analysis. From the blood, it is possible to tell if there is any infection from the white blood cell count and if you have anemia from your red blood cell count. If you have a low red blood cell count, it could mean that you have anemia.
3. Stool Test
You can be asked for a stool sample. The sample is taken to the lab for analysis. Stool is mostly used to identify gastrointestinal diseases and it can also tell if you are inflamed or bleeding.
4. Colonoscopy
Colonoscopy is a common Crohn's disease test which involves looking inside the entire colon, ileum and the rectum.
- Preparation
Before the test, you may need to have a fluid diet for 1-3 days. Enemas and laxatives will also be administered before the exam. Laxatives will increase bowel movement and loosen stool while an enema will involve flushing water, mild soap solution or laxative into your anus.
- Procedure
During the procedure, the doctor will insert a flexible tube into your anus while you are lying on your belly. The tube has a small camera that sends images to the computer screen. This way, the doctor is able to see any signs of inflammation, bleeding or ulcers. A biopsy will be performed in order to examine the tissue further using a microscope. For this, pain medication will be administered as well as sedatives so that you do not feel the biopsy.
- After Care
After the test, you might cramp and bloat, but you will be able to get back to your normal diet in no time. It is not advisable to drive for the next 24 hours to allow the sedatives to wear off.
5. Computerized Tomography (CT) Scan
Another Crohn's disease test is a CT scan. Computers and x-rays are used to form images of the organs. Prior to the test, you will be injected with a special dye or given a solution to drink. You will then lie flat on a table that will move into a tunnel-like device that captures the x-ray images. Sedation is not necessary for this test.
6. Upper GI Series (X-Rays)
For 8 hours prior to the procedure, you will be required to stay without drinking and eating. The upper GI series looks into your small intestines. During the procedure, you will drink barium (chalky fluid) and stand or sit in front of an x-ray machine. The barium covers the small intestines, making it possible to see signs of the disease better. Sedation is not required during this procedure. After the test, you might feel bloated and your stool may appear light colored because of the barium.
7. Lower GI Series (X-Rays)
Lower GI series are used to examine the large intestines. A bowel prep before the procedure is necessary and you may be on a fluid diet for 1-3 days prior to the test. Enema and laxative are used the night before the procedure. In some cases, an enema can be administered the morning of the procedure. During the procedure, a flexible tube is inserted in your anus. The large intestine will be filled with barium, making it easier for signs of the disease to be spotted on the x-ray. There is no need for sedation for this test. Normal diet can be resumed after the procedure.
Treatments for Crohn's Disease
1. Medications
Medication helps ease the symptoms of Crohn's disease. Most medications work by averting inflammation in the intestines.
- Anti-Inflammatory Drugs
Aminosalicylates are a group of anti-inflammatory drugs that are tried out first. These drugs are related to aspirin and are used to reduce inflammation of the joints and intestines. They are in tablet form and can either be taken orally or through the anus. Antibiotics can also be used to clear bacteria in the irritated areas and decrease inflammation.
- Antidiarrheal Drug
If you do not have an infection, but you are experiencing diarrhea, an antidiarrheal drug loperamide (Imodium) can be helpful.
- TNF (Tumor Necrosis Factor) Inhibitors
The latest drugs that have been approved for Crohn's disease are TNF (tumor necrosis factor) inhibitors. These drugs block TNF which is a substance produced by immune system cells, causing inflammation. The drugs are, however, accompanied by serious side effects. For this reason, they are used to treat patients who are not responding to other forms of treatment.
2. Nutritional Therapy
The doctor can recommend feeding through a tube (enteral nutrition) following a recommended diet. Parenteral nutrition (injection of nutrients into the veins) can also be recommended. This will give your bowel time to rest and relieve the symptoms.
3. Surgery
Surgery can be used to remove a section of the bowel. Surgery is recommended only for persons who have:
• Fistula that is not healing
• Symptoms are still persistent in spite of medical treatment
• Bowel obstruction