Ulcerative Colitis

Diagnosis

The diagnosis of ulcerative colitis is based on a combination of endoscopic exams, X-rays and blood and tissue tests. Upon diagnosis, patients may need additional tests to monitor the disease and diagnose possible complications or side effects of medications.

Labaratory Tests

CBC (complete blood count) tests detect high white blood cell counts, which could indicate intestinal inflammation or infection and low blood counts (anemia) which might reveal intestinal bleeding. These tests also monitor for side effects of certain medications. Liver function tests help screen for liver and bile duct abnormalities. Stool studies determine whether patients have treatable bacterial infections. Antibody tests can help clarify the situation for "indeterminate colitis" patients without a definite diagnosis.

Endoscopy

Several types of endoscope tests are used to determine if the patient has ulcerative colitis or Crohn's disease and how much bowel is affected. An endoscope is a thin, flexible tube with a lighted camera inside the tip. It is inserted into the body so doctors can examine the lining of the gastrointestinal (GI) tract. The image is magnified and appears on a television screen. The procedures are named for the section of the GI tract examined:

• Sigmoidoscopy: Examines the lining of the lower third of the large intestine (the sigmoid colon).
• Colonoscopy: Examines the lining of the entire large intestine (colon), and sometimes can peek into the very end of the small intestine (or ileum).
• ERCP (Endoscopic retrograde cholangiopancreatography): Examines the bile ducts in the liver and the pancreatic duct.

Radiology Tests

These radiologic tests provide information that endoscopy alone cannot:

Plain X-rays
Plain X-rays without contrast detect blockage in the large intestine.

X-rays With Contrast
Contrast X-rays are used together with endoscopy in monitoring and treating ulcerative colitis. These X-rays track special liquid contrast, usually barium, as it passes through the intestine, highlighting specific conditions.

CT Scan
A CT scan takes simultaneous X-rays from several angles to reconstruct images of the internal organs.

White Blood Cell Scan
Inflammation of the GI tract is characteristic of ulcerative colitis. Leukocyte scintigraphy (tagged white blood cell scan) detects white blood cell accumulation in inflamed tissue.