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Crohn’s Diagnosis & Testing

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Crohn’s disease is characterized by a range of signs and symptoms, so there is no single test that can determine the diagnosis of Crohn's with certainty.
Crohn’s disease symptoms are often similar to other conditions, including bacterial infection. To diagnose you with Crohn’s,doctors need to evaluate a combination of information and begin to exclude other potential causes of your symptoms. This process can take some time. Should you or a loved one experience symptoms, be sure to see your doctor as soon as possible.

Early Tests and Exams
First, your doctor will conduct a standard physical exam of your body and interview you to learn more about your general health, diet, family history, and environment. Bring a record of your symptoms.
Early steps in the diagnostic process can include laboratory tests of blood and stool matter, as well as X-rays of the upper and lower GI tract including the use of Barium, a chemical that helps doctors see more details of your GI tract by increasing contrast of the X-Ray image.

Endoscopy and Biopsy
Your doctor may recommend an endoscopy, which is the use of medical instruments to visually examine the interior of your colon with a small camera mounted to the end of a lighted tube. There are two types of endoscopic examinations: a colonoscopy and an upper endoscopy.
Colonoscopy involves insertion of a flexible tube through the opening of the anus and allows for the examination of the colon, the lowest part of the large intestine.
Upper Endoscopy involves the insertion of a flexible tube through the opening of the mouth, down the esophagus, into the stomach, and as far as the duodenum, the first part of the small intestine.
In addition to a visual examination, doctors will often wish to obtain a biopsy of the colon or other affected areas by removing a small piece of tissue. Biopsied tissues are then analyzed in pathology to determine the presence of disease.
While endoscopy and biopsy may sound invasive, modern medical technology and techniques have made these procedures virtually painless and easily accomplished during an outpatient visit.

Your doctor may recommend a colonoscopy to look for any polyps or pre-cancerous changes in the setting of colitis.  Chromoendoscopy is a technique of spraying a blue liquid dye during the colonoscopy in order to increase the ability of the endoscopist specialist to detect slight changes in the lining of your intestine.  The technique may identify early or flat polyps which can be biopsied or removed.  It is common to have blue bowel movements for a short time following this procedure.

Small Intestinal Imaging 
Your doctor may recommend testing to visualize the portions of your intestine that are not readily visualized by colonoscopy or endoscopy.  Typically, these tests include drinking an oral "contrast" and having a fluoroscopic x-ray, Computed Tomography (CT) scan, or Magnetic Resonance Imaging scan.  These tests are often referred to as enterographies, or if certain type of contrast is used, enteroclysis.

Alternative or additional imaging techniques for viewing the small bowel include a pill-sized camera which takes pictures of the small intestine during its transit through the bowel. These pictures are transmitted to a receiver belt.  The camera is then expelled through a bowel movement.  Specialized endoscopies to visualize the small intestine, sometimes called "balloon endoscopy", may be needed for  areas of the intestine that are hard to reach. 

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