Inflammatory Bowel Disease (IBD)

Diagnosis

Inflammatory bowel disease is diagnosed through a combination of lab tests, endoscopic procedures, and imaging studies. These tests help confirm inflammation, identify its location, and rule out other digestive disorders.

Lab tests may include:

• Blood tests to check for infection, anemia, inflammation levels, liver function and immunity against infections

• Stool studies to detect blood, harmful bacteria, parasites or markers of inflammation such as calprotectin

Endoscopic procedures used for diagnosis include:

• Colonoscopy to view the entire colon and parts of the small intestine, with the option to take biopsies for confirmation

• Flexible sigmoidoscopy to examine the rectum and sigmoid colon when full colonoscopy is not suitable

• Upper endoscopy to check the esophagus, stomach and duodenum when upper digestive symptoms are present

• Capsule endoscopy to examine the small intestine when Crohn’s disease is suspected

• Balloon-assisted enteroscopy to explore deeper areas of the small bowel when further evaluation is required

Imaging tests may include:

• X-ray to rule out complications such as toxic megacolon or perforation

• CT scan or CT enterography to assess the bowel and surrounding tissues in greater detail

• MRI or MR enterography to evaluate fistulas, small-bowel involvement and inflammation without radiation exposure

Treatment

The goal of treatment is to reduce inflammation, manage symptoms, and achieve long-term remission. Treatment options vary based on disease severity, type of IBD, and patient response.

Anti-inflammatory treatments often include:

• Aminosalicylates for mild to moderate ulcerative colitis

• Corticosteroids for short-term use to induce remission

Immunomodulators may be used to suppress the immune response that causes inflammation. These medicines are typically used when other treatments are ineffective or as part of long-term maintenance therapy.

Small-molecule medicines include JAK inhibitors and S1P receptor modulators, which help reduce inflammation by targeting specific immune pathways.

Biologic therapies target inflammatory proteins in the body. Some are given by IV infusion, while others are self-administered injections.

Antibiotics may be added when infections or perianal Crohn’s disease are present.

Other supportive medicines can help control symptoms:

• Antidiarrheals to manage frequent loose stools

• Pain relievers such as acetaminophen

• Vitamins and nutritional supplements when nutrient absorption is poor

Nutritional Support

A healthcare professional may recommend specialized nutrition plans when weight loss or malnutrition is a concern. Options may include enteral nutrition through a feeding tube or parenteral nutrition delivered through a vein.
A low-residue diet may be suggested for people with strictures to prevent blockages in narrowed sections of the bowel.

Surgery

Surgery is recommended when medicines and lifestyle changes do not control symptoms or when complications occur.

Surgery for ulcerative colitis usually involves removing the colon and rectum. An internal pouch is created and attached to the anus to allow normal stool passage. If a pouch is not possible, an ileal stoma is created for stool collection in an external bag.

Surgery for Crohn’s disease may remove damaged sections of the digestive tract, close fistulas or drain abscesses. Although surgery can relieve symptoms, Crohn’s disease often returns near the surgical site. Postoperative medicines are generally advised to reduce recurrence.