Various diagnostic tests are employed in the diagnostic process for Inflammatory Bowel Disease (IBD), particularly to differentiate between Crohn's disease and ulcerative colitis.

Diagnostic studies

A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the colonic tissue and the extent of the disease. Complementary to colonoscopy, a CT scan is indicated to identify features such as mesenteric edema, bowel wall thickening, obstructions, abscesses, and fistulas. Additionally, MRI is crucial in differentiating pelvic and perianal abscesses and fistulas.

Blood test

Blood tests are vital in the diagnostic process, with C-reactive protein and erythrocyte sedimentation rate levels indicating the degree of inflammation in the body; however, they are not specific to IBD and may also be elevated in other inflammatory conditions. Elevated white blood cell counts suggest an immune response, while low hemoglobin and hematocrit levels may indicate anemia associated with chronic inflammation and bleeding in the digestive tract.

Stool tests

Stool tests assess calprotectin levels, providing insights into intestinal inflammation, aiding diagnosis, and monitoring disease activity and treatment response.

Management

After diagnosis, the management of IBD revolves around various crucial aspects. These include giving the bowel adequate rest, addressing malnutrition, and providing symptomatic relief through medications like anti-inflammatory drugs, immunosuppressants, and biologics.

Nutritional management

Nutritional management is critical, with evidence-based strategies playing a pivotal role in disease management and improving the quality of life for patients.

A balanced diet comprising plenty of fruits, vegetables, lean proteins, and whole grains is advisable. Adequate hydration is essential, especially for patients experiencing diarrhea, and avoiding caffeine and alcohol is recommended as they can worsen symptoms. Fiber intake should be controlled, particularly for those with strictures, where a low-fiber diet may be necessary. Limiting the consumption of fatty foods is advised to mitigate the risk of developing Crohn's disease. Individual responses to certain foods may vary, and patients may benefit from keeping a food diary to identify trigger foods. Opting for small, frequent meals instead of three large ones can aid in symptom management and ensure sufficient nutrient intake. Nutrient deficiencies are common in IBD patients due to chronic diarrhea, malabsorption, increased needs, or dietary restrictions. Zinc, calcium, vitamin D, and iron supplementation may be necessary.

Specific diets, like the low FODMAP diet, have shown benefits for some IBD patients. FODMAPs are carbohydrates that can trigger symptoms like bloating, gas, stomach pain, and diarrhea. The low-FODMAP diet includes almond milk, lactose-free milk, hard cheeses, and specific fruits and vegetables like strawberries and carrots while avoiding certain dairy products, fruits, vegetables, sweeteners, and wheat products.

An individualized approach to diet is crucial due to the variability in how IBD affects individuals. Consulting with a dietitian can help tailor dietary strategies to an individual's needs, tolerance, and preferences.