I found out that it isn't easy to definitively diagnose CD or UC. Sometimes they have to eliminate everything else including irritable bowel syndrome (IBS), bacterial, and viral infection. Physician's usually use a complete blood count (CBC), liver function tests, stool samples and an endoscopy or colonoscopy. The colonoscopy or endoscopy is usually the most diagnostic of all the tests. The infected areas of a Crohn's disease is patchy and can have a cobble stone appearance. The lesions can also be go deep into the intestinal lining. In ulcerative colitis the mucosa and sub mucosa layers of the intestinal wall.
References:
http://health.ucsd.edu/specialties/gastro/inflammatory-bowel-disease/diagnosis.htm
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastro/inflammatory_bowel/inflammatory_bowel.htm
2 comments:
A way to distinguish Crohn's disease from Ulcerative Colitis is to see the areas effected. Crohn's disease affects the small intestine, especially the terminal ileum. As Dr. Cohen put it, in immunology, there are microabcesses in the wall of the intestine. Ulcerative colitis, on the other hand, is usually in the large intestine and can cause bleeding. However, it seems that both are involved in immune responses.
You are right that it can be very difficult to determine which patients have CD and which have UC. There are some patients that we label indeterminant due to this difficulty.
The most definite tool we have for diagnosis is the pathology from biopsies taken during upper endoscopy and colonoscopy. It is important that patients have both procedures (hopefully on the same day) to assist with diagnosis. While both diseases affect the stomach, typically only CD affects the small intestine.
When we have pathology showing granulomas (small abscess in the wall of the intestine) we are more confident the patient has CD. However, there are many patients with presumed CD without granulomas on their biopsies....perhaps this is sampling error (we just didn't get a biopsy that shows this finding) and perhaps this represents the variation we can see in the disease process.
The history, physical, radiology exams and other labwork all come together with the findings from the scope to make the best diagnosis we can at the time....we do change patients from UC to CD, but very rare to go from a CD diagnosis to UC.
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