Your tests in the IBD clinic

Why do we ask for them... and what do they tell us?

• Blood tests
• Stool test
• Endoscopy

What do we look for in the blood?

Blood tests

• Full blood count — to detect anaemia, or the effect of some medicines on blood cells
• Inflammation markers — such as C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR)
• Iron, vitamin B12 and vitamin D — because low levels are common in patients
• Liver and kidney function and albumin — to monitor nutrition and the safety of some treatments

Normal blood results do not rule out inflammation in every case, so they are read together with the other tests.

The calprotectin test

Stool test

A protein released by inflammatory cells inside the bowel. A high level usually points to active inflammation, though it can also rise with infection or some painkillers. A low level is reassuring in most cases, and it helps reduce the need for repeated endoscopies.

When symptoms get worse, we may also ask for a stool test to look for infection before changing treatment.

Colonoscopy

Endoscopy

It allows the bowel lining to be seen directly and small, painless samples (biopsies) to be taken. It is used for diagnosis, to assess the response to treatment, and to detect pre-cancerous changes early.

It needs bowel preparation following the instructions, and may be done under light sedation.

Imaging the bowel without radiation

Scans

• Bowel ultrasound — quick, with no complicated preparation, and can be repeated in clinic to monitor inflammation
• MRI — shows the small bowel and complications, and is used to assess a fistula around the back passage (anus)

We avoid repeated CT scans as far as possible to reduce radiation exposure; CT is used when urgently needed.

Regular checks to protect you

Prevention

• Tuberculosis (TB) and hepatitis screening — before starting immune-suppressing and biologic treatments
• Reviewing vaccinations — regularly, and before starting any immune-suppressing treatment
• Bone density — with repeated steroid use or low vitamin D
• Surveillance colonoscopy — about 8 years after symptoms began, then regularly depending on risk; with primary sclerosing cholangitis it starts at diagnosis and is repeated every year

How to prepare for your tests

Preparation

• Bring a list of all your medicines — including herbal remedies and supplements
• Follow the preparation instructions carefully — especially fasting and bowel preparation before endoscopy
• Tell us about blood thinners or diabetes medicines — they may need adjusting before endoscopy
• Ask about your result — and find out what it means for your treatment plan

Your tests: the summary

Key messages

• Each test has a specific purpose in your follow-up
• Calprotectin helps with follow-up without repeated endoscopy
• Endoscopy shows the lining directly and detects changes early
• Ultrasound and MRI are radiation-free tests
• Regular checks protect you from complications of the disease and its treatment

Contact the clinic if:

• The preparation instructions are unclear
• You need to change a test appointment
• New symptoms appear
• You take blood-thinning medicines
• An important test result has not arrived
• You have questions about your result

If you have severe tummy pain, bleeding or a fever after an endoscopy, go straight to the nearest emergency department.