How Is Ulcerative Colitis Diagnosed
To diagnose ulcerative colitis in children, teenagers and adults, your healthcare provider has to rule out other illnesses. After a physical exam, your provider may order:
- Blood tests: Your blood can show signs of infection or anemia. Anemia is a low level of iron in your blood. It can mean you have bleeding in the colon or rectum.
- Stool samples: Signs of infection, parasites , and inflammation can show up in your poop.
- Imaging tests: Your healthcare provider may need a picture of your colon and rectum. You may have tests including a magnetic resonance imaging scan or computed tomography scan.
- Endoscopic tests: An endoscope is a thin, flexible tube with a tiny camera. Specialized doctors can slide the endoscope in through the anus to check the health of the rectum and colon. Common endoscopic tests include colonoscopy and sigmoidoscopy.
What Can I Expect From The Test Results
Your doctor will typically talk with you about your results after the procedure, and they will be either negative or positive. Negative results mean nothing abnormal was found during the test. Positive results mean that polyps or other abnormal tissue was found during the exam. If youve only had a sigmoidoscopy, your doctor may want to schedule a colonoscopy to see the rest of your colon, per the Mayo Clinic. If your colonoscopy results were positive, your doctor will talk with you about a treatment plan moving forward.
What Are The Symptoms Of Ulcerative Colitis
Ulcerative colitis symptoms often get worse over time. In the beginning, you may notice:
- Diarrhea or urgent bowel movements.
- Abdominal cramping.
- Liver disease.
- Loss of fluids and nutrients.
Symptoms are similar in pediatric ulcerative colitis and may also include delayed or poor growth. Some ulcerative colitis symptoms in children can mimic other conditions, so it is important to report all symptoms to your pediatrician.
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What Should I Ask My Doctor On Behalf Of My Child Or Teenager
Ask your healthcare provider the following questions in addition to the ones listed above:
- What vitamins should my child take?
- Will my other children have pediatric ulcerative colitis?
- Is my child at risk for other conditions?
- Can you recommend a psychiatrist or therapist to help my child with emotional issues related to pediatric ulcerative colitis?
- Is my child growing at a normal rate?
- What can I do to help my child cope at school?
A note from Cleveland Clinic
When you have ulcerative colitis, its essential to work closely with your healthcare team.
Take your medications as prescribed, even when you dont have symptoms. Skipping medications youre supposed to take can lead to flareups and make the disease harder to control. Your best shot at managing ulcerative colitis is to follow your treatment plan and talk to your healthcare provider regularly.
Diagnosing Inflammatory Bowel Disease In Adults
In inflammatory bowel disease, or IBD, there is persistent inflammation in the gastrointestinal tract. The condition causes symptoms such as abdominal pain, diarrhea, bloody stool, constipation, and an urgent need to have a bowel movement. The most common types of IBD are Crohns disease and ulcerative colitis.
Gastroenterologists at NYU Langoneâs Inflammatory Bowel Disease Center are experts in the gastrointestinal tract and can recommend the appropriate diagnostic tests to determine the cause of your symptoms. There is no single definitive test to confirm the presence of IBD, so the condition is diagnosed based on a combination of tests, including endoscopy, biopsy, and imaging tests.
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Can I Prevent Ulcerative Colitis
There is currently no known way to prevent or cure for ulcerative colitis but the proper strategy for managing your disease can help you lead a happier, healthier, fulfilling life.
The exact cause of ulcerative colitis is unknown. However, it is believed to be due to a combination of factors, including a persons genes and triggers in the environment. This interaction of genetic and environmental factors activates an abnormal response of the bodys immune system.
Normally, the immune system protects the body from infection. In people with ulcerative colitis, however, the immune system can mistake microbes , food, and other material in the intestines, as invading substances.
When this happens, the body launches an attack, sending white blood cells into the lining of the intestines where they cause inflammation and ulcerations.
Ulcerative Colitis And Cancer Of The Colon
The chance of developing cancer of the large intestine is higher than average in people who have had ulcerative colitis for several years or more. It is more of a risk if you have frequent flare-ups affecting the whole of the large intestine. For example, about 1 in 10 people who have ulcerative colitis for 20 years which affects much of their large intestine will develop cancer.
Because of this risk, people with ulcerative colitis are usually advised to have their large intestine routinely checked after having had the condition for about 10 years. This involves a look into the large intestine by a flexible telescope every now and then and taking small samples of bowel for examination. It is usually combined with chromoscopy – this is the use of dye spray which shows up suspicious changes more easily. Depending on the findings of this test and on other factors, you will be put into a low, intermediate or high risk category. ‘Other factors’ include:
- The amount of intestine affected.
- Whether you have had complications such as polyps. These are small, non-cancerous growths on the inside lining of the colon or rectum.
- Whether you have a family history of cancer.
The National Institute for Health and Care Excellence recommends the next colonoscopy/chromoscopy should depend on the degree of risk of developing colon or rectal cancer. After the next test, your risk will be calculated again.
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Causes Of Ulcerative Colitis Flares
Ulcerative colitis flares can be caused by a variety of things, including:
- Skipping medications or not taking the correct dose. If you regularly take medicine for your ulcerative colitis, you need to be consistent even when your disease is in remission. If you dont follow prescription instructions, flares can occur.
- Taking non-steroidal anti-inflammatory drugs. Common drugs like aspirin, naproxen, and ibuprofen can inflame the bowel and bring on serious symptoms. If you need mild pain relief or fever treatment, you should take acetaminophen.
- Taking antibiotics. Although theyre useful when you have bacterial infections, they affect the bacteria that live in your intestine. These changes can result in diarrhea or the growth of too much of a certain bacteria that then causes inflammation. If you have a bacterial infection, make sure your healthcare provider knows you have ulcerative colitis.
- Not managing stress. Physical and emotional stress can bring on flare-ups. Once you understand that stress causes such a reaction, you can find out what stress management strategies work to keep flare-ups at bay.
- Eating and drinking triggering items. The foods and drinks that bring on symptoms vary by person. Youll need to track your diet so you can pinpoint triggering items when you experience ulcerative colitis flares.
Can I Get Surgery For My Ulcerative Colitis
Surgery is an option if medications arent working or you have complications, such as bleeding or abnormal growths. You might develop precancerous lesions, or growths that can turn into colorectal cancer. A doctor can remove these lesions with surgery or during a colonoscopy.
Research shows that about 30% of people with ulcerative colitis need surgery sometime during their life. About 20% of children with ulcerative colitis will need surgery during their childhood years.
There are two kinds of surgery for ulcerative colitis:
Proctocolectomy and ileoanal pouch
The proctocolectomy and ileoanal pouch is the most common procedure for ulcerative colitis. This procedure typically requires more than one surgery, and there are several ways to do it. First, your surgeon does a proctocolectomy a procedure that removes your colon and rectum. Then the surgeon forms an ileoanal pouch to create a new rectum. While your body and newly made pouch is healing, your surgeon may perform a temporary ileostomy at the same time. This creates an opening in your lower belly. Your small intestines attach to the stoma, which looks like a small piece of pink skin on your belly.
After you heal, waste from your small intestines comes out through the stoma and into an attached bag called an ostomy bag. The small bag lies flat on the outside of your body, below your beltline. Youll need to wear the bag at all times to collect waste. Youll have to change the bag frequently throughout the day.
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What Is A Fecal Occult Blood Test
A fecal occult blood test is used to detect hidden blood in the stool that is not easily visible.5 The presence of blood in the stool indicates that there is some type of bleeding occurring in the colon, but there are many conditions that can cause bleeding in the digestive tract, including diverticulitis, polyps , colon cancer, hemorrhoids or ulcers. Polyps and colorectal cancer can cause some of the same symptoms as CD and UC, such as:
- Abdominal pain or tenderness
When Should You Call Your Doctor
if you have been diagnosed with ulcerative colitis and you have:
- Fever over 38.3Â°C or shaking chills.
- Light-headedness, passing out, or rapid heart rate.
- Stools that are almost always bloody.
- Severe dehydration, such as passing little or no urine for 12 or more hours.
- Severe belly pain with or without bloating.
- Pus draining from the area around the anus or pain and swelling in the anal area.
- Repeated vomiting.
- Not passing any stools or gas.
If you have any of these symptoms and you have been diagnosed with ulcerative colitis, your disease may have become significantly worse. Some of these symptoms also may be signs of toxic megacolon. This is a condition in which the colon swells to many times its normal size. Toxic megacolon requires emergency treatment. Left untreated, it can cause the colon to leak or rupture. This can be fatal.
People with ulcerative colitis usually know their normal pattern of symptoms. Call your doctor if there is a change in your usual symptoms or if:
- Your symptoms become significantly worse than usual.
- You have persistent diarrhea for more than 2 weeks.
- You have lost weight.
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Southern Cross Medical Library
The purpose of the Southern Cross Medical Library is to provide information of a general nature to help you better understand certain medical conditions. Always seek specific medical advice for treatment appropriate to you. This information is not intended to relate specifically to insurance or healthcare services provided by Southern Cross. For more articles go to the Medical Library index page.
Ruling Out Other Conditions
The symptoms of Crohns and Colitis can often be quite similar to other conditions like Irritable Bowel Syndrome , so your GP should first order some tests to rule them out. These tests cant confirm whether or not you have Crohns or Colitis, but they can help narrow down the possible causes of your symptoms.
For years I was misdiagnosed with skin conditions and allergies it only was after finally getting a faecal calproctectin test that I was diagnosed with Colitis. One year later, I’m in remission and getting on with my life.
Megan, age 25Living with Colitis
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Ct Scans And Ct Enterography
CT scans involve taking a series of X-rays to create detailed two- and three-dimensional images of the body. CT scans of the gastrointestinal tract can reveal a narrowing of the small or large intestine, called a stricture, or an obstruction. The test may also indicate inflammation in the small intestine, which suggests that Crohns disease may be causing your symptoms.
Occasionally, doctors may recommend an enhanced CT scan, known as a CT enterography. Prior to the scan, you drink a contrast agent. As the liquid passes through the digestive tract, the CT scanner takes pictures of the small intestine and may reveal anatomical problems. For example, if an obstruction is present, the contrast liquid is visibly blocked.
When Should Uc Complicated By Cmv Infection Be Suspected
Although patients with UC may require early diagnosis and appropriate treatment of CMV infection, CMV may become sporadically reactivated in such patients and then disappear even without prescription of antiviral agents. Matsuoka et al. assayed CMV levels at 2-week intervals for 8 weeks in 69 patients with severe UC to assess CMV reactivation. Such reactivation was diagnosed by CMV antigenemia or CMV PCR . Forty-eight patients were positive for CMV IgG, and half showed evidence of CMV reactivation. No significant difference in the rate of either remission or colectomy was evident between the CMV reactivation and the other group reactivation resolved without antiviral therapy in most patients. do Carmo et al. found that it was rare for patients with IBD to develop an active CMV infection . Therefore, blood tests exploring CMV infection status need not be performed in all IBD patients.
Recently reported risk factors for CMV disease in IBD patients include age > 30 years, immunomodulatory treatment, and refractoriness to drugs such as corticosteroids or TNF antagonists . Another study found that a leukocyte count < 11,000/mL and a disease duration < 60 months were risk factors for CMV infection, in addition to age 30 years and immunosuppressant use . Thus, CMV infection status should be determined in older UC patients who are refractory to immunomodulators such as high-dose steroids, or whose symptoms persist or deteriorate as the steroid dose is reduced.
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Microscopic Featuresappraisal Of The Diagnosis
4.3.1 Early stage disease
It has been proposed that a non-specific increase in the inflammatory infiltrate in the lamina propria in combination with absent crypt architectural distortion, indicates a diagnosis of acute, infective colitis, rather than UC. This finding, however, is not confirmed in those studies of patients with early onset colitis .,
Basal plasmacytosis at the initial onset has a high predictive value for the diagnosis of IBD Repeat biopsies after an interval may help to solve differential diagnostic problems and establish a definitive diagnosis especially in adults, by showing additional features
Basal plasmacytosis is observed in biopsies obtained at early onset in 38100% of adult patients, and can help differentiate between UC and infectious colitis. It is particularly a feature in young children in these cases it is notably present in rectal biopsies and decreases proximally. It is an early feature, sometimes the first lesion to appear,,,, and a good predictive marker.
In young children or patients with an aberrant presentation of colitis, UC should always be considered in the differential diagnosis even if the pathology is not typical
Reliable diagnostic features may be absent from biopsies obtained in early onset disease, in acute severe colitis, or in patients with an atypical immunological response . The routine use of additional techniques such as immunohistochemistry is not recommended at present.
4.3.2 Established disease
What Imaging Tests Are Used In The Diagnosis Of Ulcerative Colitis
If your laboratory reports are suggestive of inflammatory bowel disease , they will refer you to a gastroenterologist. A gastroenterologist is a doctor who specializes in treating digestive system disorders. The gastroenterologist will recommend that you undergo tests, such as sigmoidoscopy and colonoscopy. Each of the procedures requires you to take laxatives a night before to empty your colon.
- A sigmoidoscopy involves the insertion of a flexible tube-like camera into the anus to view the inside of the rectum and lower part of the colon.
- This procedure helps the doctor know the extent of inflammation and ulcers, if any, in the lower colon.
- The procedure usually takes about 15 to 20 minutes and you can go home the same day.
- If you have been given medicines that make you sleepy, you need to stay for a few hours at the clinic or hospital until the doctor allows you to go home.
X-rays or computed tomography scan
- If your doctor wants to check if you have developed any complications of ulcerative colitis, they may order additional tests, such as a CT scan or X-ray of your abdomen. A CT scan uses strong radiation to get detailed images of the colon and other organs of your abdomen.
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Who Gets Ulcerative Colitis And What Causes It
Colitis can develop at any age, but usually first appears in people aged 15 to 30.
Experts are not sure why UC or Crohn’s disease occurs in some people. It may be due to a combination of genetic, environmental and infectious factors that cause a fault in the immune system leading to inflammation of the bowel.
How Ulcerative Colitis Is Diagnosed
Ulcerative colitis has symptoms similar to many other digestive conditions, which can make diagnosis challenging. Because treatment is needed to induce remission and to prevent the disease from worsening, getting an accurate and timely diagnosis is important.
Gastroenterologists may use a variety of tests in order to understand whats going on with a patient who is suspected of having ulcerative colitis, but it is typically a colonoscopy with biopsies that is used to make the diagnosis.
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Who Diagnoses Ulcerative Colitis
If you have symptoms of ulcerative colitis, your regular healthcare provider will probably refer you to a specialist. A gastroenterologist a doctor who specializes in the digestive system should oversee the care for adults. For young patients, a pediatric gastroenterologist who specializes in children should manage the care.