Inflammatory bowel disease (IBD)

Diagnosis

To find out if someone has inflammatory bowel disease, a healthcare professional may use several tests and procedures. Diagnosis usually includes stool tests, blood tests and a colonoscopy. It also may include imaging tests.

Lab tests

These may include:

• Blood tests. Blood tests can check for signs of infection, inflammation or anemia — a condition in which there are reduced numbers of red blood cells.

  These tests also may be used to check liver function or the presence of infections that aren't active, such as tuberculosis.

• Stool tests. A stool sample may be tested for blood, infection-causing bacteria and, rarely, parasites. These can be causes of diarrhea and symptoms. Sometimes looking for stool markers of inflammation, such as calprotectin, can be helpful.

Endoscopic procedures

These tests use a thin tube with a light and camera to look inside the digestive tract:

• Colonoscopy. This lets a healthcare professional look at the whole colon and part of the small intestine. A small tissue sample, called a biopsy, may be taken. A biopsy is the way to make the diagnosis of IBD versus other forms of inflammation.
• Flexible sigmoidoscopy. This checks the rectum and lower part of the colon. If the colon is badly inflamed, this test may be done instead of a full colonoscopy.
• Upper endoscopy. This checks the esophagus, stomach and first part of the small intestine. While it is rare for these areas to be involved with Crohn's disease, this test may be recommended if you are having nausea and vomiting, difficulty eating, or upper abdominal pain.
• Capsule endoscopy. This test is sometimes used to help diagnose Crohn's disease involving the small intestine. For this test, you swallow a capsule that has a camera in it. The images are transmitted to a recorder you wear on your belt, after which the capsule exits your body painlessly in your stool.
• Balloon-assisted enteroscopy. This test lets the technician look farther into the small bowel where standard endoscopes don't reach. This technique is useful when capsule endoscopy results raise concerns, but more testing is needed to make a diagnosis.

Imaging tests

Common imaging tests used to help diagnose inflammatory bowel disease include:

• X-ray. If you have severe symptoms, your healthcare professional may use a standard X-ray of your abdominal area to rule out serious complications, such as toxic megacolon or a perforated colon.

• CT scan. A CT scan is a special X-ray technique that provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues outside the bowel.

  CT enterography is a special CT scan that involves drinking an oral contrast material and getting intravenous contrast images of the intestines. This test provides better images of the small bowel and has replaced barium X-rays in many medical centers.

• MRI. An MRI scan uses a magnetic field and radio waves to create detailed images of organs and tissues. MRI used with a contrast fluid, called MR enterography, is particularly useful for evaluating a fistula around the anal area or the small intestine.

  Sometimes MR enterography can be performed to check for disease status or progression. This test may be used instead of CT enterography to reduce the risk of radiation, especially in younger people.

• Ultrasound. Similar to CT and MRI, an ultrasound of your intestines can be performed to assess for inflammation and complications related to Crohn's disease.

• Capsule endoscopy. This test involves swallowing a capsule with a camera in it. The camera takes pictures of the small intestine and sends them to a recorder worn on a belt. The images are then downloaded to a computer, displayed on a monitor and checked for signs of Crohn's disease. The camera exits the body painlessly in stool.

  Endoscopy with biopsy may still be necessary to confirm a diagnosis of Crohn's disease. Those with Crohn's disease of the small intestine may be at a higher risk of the capsule getting stuck in the intestine, especially if there is a history of narrowing or surgery of the small intestine. Capsule endoscopy should not be done if there is a suspected stricture or blockage, also called an obstruction, in the bowel.

Treatment

Treatment for inflammatory bowel disease aims to lower inflammation, improve symptoms and help prevent complications. Treatment may include medicines, surgery or both.

The type of treatment recommended depends on several factors, including how severe the disease is, which parts of the digestive tract are affected, and whether complications are present. Treatment plans often change over time based on how the condition responds.

Medicines

Medicines may include:

• 5-aminosalicylates (5-ASA). These anti-inflammatory medicines are often the first step in the treatment of ulcerative colitis, typically for mild to moderate disease. They include mesalamine (Rowasa, others), balsalazide (Colazal) and olsalazine (Dipentum).
• Corticosteroids. Corticosteroids such as prednisone and budesonide (Entocort EC) can help reduce inflammation in the body, but they don't work for everyone. Sometimes, IV corticosteroids are used in the hospital setting. Corticosteroids may be used for a short time to improve symptoms and to help calm the inflammation.
• Immunomodulators. These medicines lower immune system activity that contributes to inflammation. Examples of immunosuppressant medicines include azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan) and methotrexate (Trexall).
• Small molecules. Janus kinase (JAK) inhibitors are a type of small molecule medicine. They help reduce inflammation by targeting parts of the immune system that cause inflammation in the intestines. JAK inhibitors for IBD include tofacitinib (Xeljanz) and upadacitinib (Rinvoq). Ozanimod (Zeposia) and etrasimod (Velsipity) are another type of small molecule medicine available for IBD.
• Biologics. These target proteins in the body that cause inflammation. Some are given by infusion, and some are given by injection. Examples include infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). They include certolizumab pegol (Cimzia), vedolizumab (Entyvio) and ustekinumab (Stelara). They also include risankizumab (Skyrizi), mirikizumab (Omvoh) and guselkumab (Tremfya).
• Antibiotics. Antibiotics may be used when infection is a concern. Often-prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).

Nutritional support

If weight loss is serious, a healthcare professional may suggest special nutrition through a feeding tube or a vein. If there is a narrowing in the bowel, a low-residue diet may be recommended.

Surgery

Surgery may be recommended if medicines and lifestyle changes do not help enough.

• Surgery for ulcerative colitis. This may involve removing the colon and rectum. In some cases, surgeons create an internal pouch so stool can still leave the body through the anus.
• Surgery for Crohn's disease. Surgery may remove a damaged part of the digestive tract, close fistulas, or drain abscesses. Surgery does not cure Crohn's disease, and the disease may come back later. The best approach is to follow surgery with medicine to lessen the risk of recurrence.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Healthy habits may help manage symptoms, but they do not replace medical treatment.

Diet

There is no clear proof that food causes IBD. Still, some foods and drinks may make symptoms worse, especially during a flare-up.

These tips may help:

• Keep a food diary to track what seems to trigger symptoms.
• Eat smaller meals more often.
• Drink plenty of liquids. Water is best.
• Limit dairy products if they make symptoms worse.
• Ask your healthcare team about vitamins or meeting with a dietitian if your diet becomes limited.

Smoking

Smoking raises the risk of Crohn's disease and can make it worse. People with Crohn's disease who smoke are more likely to have relapses and need medicines and repeat surgeries.

Stress

Stress may make symptoms harder to manage for some people. These steps may help:

• Exercise. Even mild exercise can help reduce stress, relieve depression and adjust bowel function. Talk with your healthcare professional about an exercise plan that's right for you.
• Cognitive behavioral therapy. This type of talk therapy can help you manage stress, anxiety and depression by changing unhelpful thought patterns and building coping skills.
• Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to help you feel calm.

Alternative medicine

Many people with digestive disorders use some form of complementary or alternative medicine. But there is little research on how safe and effective these treatments are. Talk with your healthcare team before taking these treatments.

Coping and support

IBD doesn't just affect you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. Even if your symptoms are mild, you may find it difficult to be out in public. All of these factors can alter your life and may lead to depression. Here are some things you can do:

• Be informed. One of the best ways to better manage your IBD is to find out as much as possible about inflammatory bowel disease. Look for information from reputable sources such as the Crohn's and Colitis Foundation.
• Join a support group. Although support groups aren't for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among others with IBD.
• Talk with a therapist. Some people find it helpful to consult a mental health professional who's familiar with inflammatory bowel disease and the emotional difficulties it can cause.

Although you may feel discouraged about living with IBD, research is ongoing, and treatment continues to improve.

Preparing for your appointment

Symptoms of inflammatory bowel disease may first lead to a visit with your main healthcare team. However, you may then be referred to a professional who specializes in treating digestive disorders, called a gastroenterologist.

Because appointments can be brief, and there's often a lot of information to discuss, it's a good idea to be well prepared. Here's some information to help you get ready and what to expect at your visit.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:

• Your symptoms, including any that seem unrelated to the reason for your appointment.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medications, vitamins or other supplements you take, including the doses.
• Questions to ask your doctor.

Take a family member or friend along, if possible, to help you remember the information you're given.

For inflammatory bowel disease, some basic questions to ask your doctor include:

Symptoms and diagnosis

• What's causing these symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need?
• Do these tests require any special preparation?
• Is this condition temporary or long lasting?

Treatment and medicines

• What treatments are available, and which do you recommend?
• Are there any alternatives to the primary approach that you're suggesting?
• Are there any medicines that I should avoid?
• What types of side effects can I expect from treatment?
• Is there a generic alternative to the medicine you're prescribing?

Follow-up care and daily life

• What sort of follow-up care do I need?
• How often do I need a colonoscopy?
• I have other health conditions. How can I best manage them together?
• Do I need to change my diet?

Pregnancy and family risk

• Is there a risk to me or my child if I become pregnant?
• If I have IBD and my partner becomes pregnant, is there a risk of pregnancy complications?
• What is the risk of my child having IBD if I have it?

Resources and support

• Are there brochures or other printed material that I can take with me?
• What websites do you recommend?
• Are there support groups for people with IBD and their families?

What to expect from your doctor

Your healthcare team is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. You may be asked about:

Symptoms

• When did your symptoms begin?
• Are your symptoms always there or do they come and go?
• How bad are your symptoms?
• Do you have belly pain?
• Have you had diarrhea? How often?
• Do you awaken from sleep during the night because of diarrhea?
• Do your symptoms affect your ability to work or do other activities?
• Does anything seem to improve your symptoms?
• Is there anything that you've noticed that makes your symptoms worse?

Health history

• Have you lost weight without trying to?
• Have you ever had liver problems, hepatitis or jaundice?
• Have you had problems with your joints, eyes or skin — including rashes and sores — or had sores in your mouth?
• Do you smoke?
• Do you have a family history of inflammatory bowel disease?

Recent exposures

• Have you recently traveled? If so, where?
• Is anyone else in your home sick with diarrhea?

Medicines

• Do you take nonsteroidal anti-inflammatory medicines, for example, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or diclofenac sodium? These medicines also are called NSAIDs.
• Have you recently taken antibiotics?