Diagnosing Crohn’s disease isn’t exactly straightforward. Unfortunately, there’s no single Crohn’s disease test that can quickly confirm whether you have the condition or not.
Crohn’s disease is a type of inflammatory bowel disease (IBD) that causes inflammation anywhere in your digestive tract. Diarrhea, abdominal pain, and stomach cramping are some of the most common Crohn’s disease symptoms, but you may have less obvious symptoms, such as red eyes, joint pain, rashes, or fatigue, if your case is severe and you have a lot of bodily inflammation, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). That often makes reaching a diagnosis confusing, as the hallmark signs of Crohn’s disease can be similar to those of other conditions, like ulcerative colitis or irritable bowel syndrome.
“A Crohn’s disease diagnosis typically begins with taking a patient’s history,” Benjamin Lebwohl, M.D., gastroenterologist and associate professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, tells SELF. That includes discussing your own medical history and your family’s medical history to see if you have a higher risk of developing Crohn’s disease. Then, you’ll dive into the type of symptoms you’re experiencing, how long the issues have lasted, how much pain you’re in, and what your bowel movements are like, Dr. Lebwohl says.
Your doctor will also do a physical exam to check for bloating and tenderness in your abdomen or signs of an enlarged liver or spleen. The next step? You’ll schedule diagnostic tests to help your doctor pinpoint the cause of your symptoms—here’s what that might entail to reach a Crohn’s diagnosis.
Lab tests
Lab tests can’t 100% verify whether you have Crohn’s disease, but there are two types that can offer some important clues that you might have the condition:
Blood tests can identify whether you have fewer red blood cells than normal or a higher white blood cell count than normal, according to the NIDDK. Anemia is a big side effect of Crohn’s disease, which means you don’t have enough red blood cells to carry oxygen throughout your body, according to the Mayo Clinic. People with Crohn’s disease often develop anemia due to bleeding in their digestive tract, which can be accompanied with symptoms like having blood in their stools or feeling really tired. When you have a high white blood cell count, on the other hand, that’s a sign you may have inflammation or an infection in your body.
You will likely also give a stool sample that’s tested for blood and other possible digestive problems, like infections caused by parasites, and signs of inflammation, according to the Mayo Clinic. Your doctor will give you instructions on how to do the test and you’ll get a container to catch and store the stool (which isn’t super fun, but at least you’ll get to do that part yourself).
Imaging tests
Your doctor may also choose to do imaging tests so they can get a better look at your digestive tract. These generally include:
A CT scan is a more detailed type of X-ray that allows your doctor to see high-quality images of your whole bowel and surrounding tissues. Using this information, your doctor can look for signs of Crohn’s disease, such as inflammation, according to the Mayo Clinic.
To prepare for a CT scan, you’ll drink a fluid that contains something called contrast medium, which is a unique dye that helps the tissues in question show up better on the CT scan. During the procedure, you lie down on a table that slides into a tunnel-shaped machine, where the scans are done.
MRI is another test that gets detailed images of your organs and tissues. MRI is good at detecting fistula, which is when two body parts don’t connect together properly, around the anus or the small intestine, according to the Mayo Clinic. (This may happen because of inflammation involved with Crohn’s disease.) According to a 2021 research review published in Insights Into Imaging,1 MRI is an effective way to detect Crohn’s in the small bowel and related complications and can be used as a radiation-free alternative to a CT scan.
An upper G.I. series is a type of X-ray that involves drinking a chalky liquid called barium, which makes your upper G.I. tract more visible on the test. Generally, the process also includes a method called fluoroscopy, where an X-ray beam is constantly passed through your G.I. tract to create a movie of sorts, showing how the barium travels through your esophagus, stomach, and small intestine, per Johns Hopkins Medicine. This method can show abnormalities related to many digestive problems, including Crohn’s disease, as well as swallowing problems, stomach ulcers, cancer, hernias, and more.
Endoscopy
Endoscopy is a procedure where a long, bendy tube with lights and a camera on the end (endoscope) is inserted into the digestive tract—either via the mouth or the anus—to show exactly what is going on inside. They’re the most accurate way to diagnose Crohn’s and rule out other potential conditions, according to the NIDDK. There are three different types of endoscopy used for diagnosing Crohn’s disease, and your doctor will choose which one is best based on your symptoms.
Most often, your doctor will recommend a colonoscopy if they think you have Crohn’s disease. During the procedure, an endoscope is inserted into the anus to view the rectum, colon (large intestine), and the terminal ileum (the very end of the small intestine). Before a colonoscopy, you have to do bowel prep, which includes a special drink or enema to clean out your bowels so your doctor gets the clearest view possible of your insides. A colonoscopy is usually done under general anesthesia.
If Crohn’s is suspected, your doctor will likely take a biopsy, or tissue sample, from your digestive tract. If the biopsy shows that you have inflammatory cells (called granulomas), then you’ll typically get diagnosed with Crohn’s disease. “All tests and scans matter, but the findings on a biopsy are critical,” Peter D.R. Higgins, M.D., Ph.D., professor of gastroenterology and director of the IBD Program at the University of Michigan, tells SELF. “It’s hard to make the call without a definitive biopsy.”
An upper G.I. endoscopy is similar to a colonoscopy, except it comes in from the other end. This doesn’t involve bowel prep, and typically you’ll be given liquid anesthesia to numb your throat and be put under a sedative—not general anesthesia. The endoscope goes down your esophagus and gives your doctor a good look at your throat, stomach, and duodenum (the beginning of your small intestine) to see if there is any inflammation or bleeding. Similar to a colonoscopy, your physician may take tissue samples to test for inflammation that can indicate you have Crohn’s disease, according to the Mayo Clinic.
This is generally recommended when other tests are inconclusive, according to NYU Langone. During a capsule endoscopy, you swallow a capsule that contains a teeny-tiny camera, which then takes photos of your small intestines. The camera eventually passes in your stool (you shouldn’t even notice it).
An enteroscopy is used to examine the small intestine with a specialized endoscope that can reach further down your G.I. tract and give a better view of the area. If your doctor thinks your symptoms, like severe pain and diarrhea, are due to Crohn’s affecting your small intestine, then you might have an enteroscopy. There are a few different types of enteroscopy your doctor may use to be able to fully examine the small intestine:
- Push enteroscopy, which uses a longer endoscope that can reach the small intestine
- Single- or double-balloon enteroscopy, which uses small balloon-like devices called overtubes to reach the small intestine
- Spiral enteroscopy, which uses a tube attached to an endoscope that works kind of like a corkscrew
When to see a doctor for Crohn’s disease testing
If you have ongoing changes in your bowel movements, such as bloody stool, abdominal pain, or persistent diarrhea that can’t be explained, then it’s important to see your doctor. You can start by scheduling an appointment with your primary care physician if you have one to talk about what’s going on and get a referral to a gastroenterologist if necessary.
If you do get diagnosed with Crohn’s disease, then your doctor will work with you to figure out the best treatment to get your symptoms under control. There’s no cure for Crohn’s disease, but the right treatment (or combination of medications) can decrease inflammation and prevent flares so that the disease doesn’t interfere with your life on a daily basis.
While the road to getting a definitive Crohn’s diagnosis can sometimes be long and require multiple tests and scans, getting a diagnosis as early as possible will prevent further damage in your G.I. tract and help you feel better sooner. Each test and scan will get you one step closer to finding some relief.
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