How is Crohn’s disease (CD) diagnosed?

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A person living with Crohn’s disease (CD) may experience many different symptoms that are caused by the disease and its complications.1,2 Inflammation inside of the digestive tract can cause symptoms spanning the mouth to the anus. Some patients have inflammation that occurs outside of the digestive tract, which can cause other symptoms affecting other areas and functions of the body.

Common symptoms of CD are:

If a patient is experiencing symptoms that might be caused by CD, then a healthcare provider will take steps to find out if the symptoms are actually being caused by CD or if they are the result of some other condition or cause. The following conditions can cause symptoms that are similar to the symptoms of CD:

  • Stomach flu (gastroenteritis)
  • Traveller’s diarrhea
  • Celiac disease
  • Gallbladder disease
  • Pancreatitis
  • Stomach ulcers
  • Irritable bowel syndrome
  • Colorectal cancer

There is no single test that can be used to diagnose CD directly. This means that the process of finding out if a patient’s symptoms are being caused by CD involves several steps, many of which are focused on ruling out other causes for the symptoms. Typically, the process of diagnosing CD will include:

  • Taking the patient’s medical history
  • Performing a physical examination
  • Laboratory testing of the patient’s blood and stool
  • Diagnostic procedures called “endoscopy”
  • Diagnostic imaging and scanning

What happens when the healthcare provider takes a medical history?

A first step in diagnosing CD is taking the patient’s medical history.1,2 The healthcare provider will ask questions about the patient’s symptoms, such as:

  • What kinds of symptoms the patient has been having
  • Where in the body the symptoms are located
  • When the symptoms started
  • How severe the symptoms are
  • What tends to make the symptoms better or worse
  • Whether there is a pattern to the symptoms, such as the frequency and consistency of bowel movements
  • How the symptoms affect the patient’s life, such as causing absences from school or work

The healthcare provider will learn about the patient’s health history and find out if there are any other members of the patient’s family who have inflammatory bowel disease. People who have an immediate family member with CD are more likely to develop CD themselves; however, most people with CD do not have a family member with the disease.

Because many of the symptoms of CD can also have various other kinds of causes, the healthcare provider may also ask questions about whether the patient:

  • Has travelled recently
  • Has taken antibiotics or other medications recently
  • Has any food intolerances
  • Is a current or former smoker

What happens during the physical examination for CD?

During the physical examination, the healthcare provider checks the patient’s heart rate, blood pressure, temperature and body weight.1,3 The provider also examines and listens to the patient’s abdomen to check for tenderness and swelling.

Many people with CD have symptoms in the rectum or anus that are caused by perianal disease. To check for signs of perianal disease, the healthcare provider will usually perform a rectal examination. Symptoms of perianal disease include:

  • Areas of inflammation and collected pus (an abscess)
  • Tunnels that have developed around the anus (a fistula)
  • Tear or split around the anal canal (an anal fissure)
  • Narrow skin growths (skin tags)
  • Narrowing of the digestive tract (a stricture)
  • Hemorrhoids

What types of laboratory tests can be used to help diagnose CD?

After the taking the patient’s medical history and performing the physical examination, the healthcare provider may ask the patient to provide small samples of blood and stool for further testing.1,2,4 These tests can be used to help detect whether there is inflammation or infection present in a person’s body that may be caused by CD. They can also be used to help find out if the inflammation or infection is the result of some cause other than CD.

What kinds of procedures are used to help diagnose CD?

Healthcare providers may recommend further diagnostic procedures based on the results of the patient’s medical history, physical examination, and laboratory tests. 1,2,4 Although a patient’s symptoms and the results of laboratory tests can aid in the diagnosis of CD, diagnostic procedures are needed to detect more specific signs of the disease inside a patient’s digestive tract.

Endoscopy procedures allow a healthcare provider to look inside a patient’s digestive tract using a tiny camera and light that are attached to a very thin, flexible tube inserted into the body. The most common type of endoscopic procedure used to diagnose CD is colonoscopy.

Diagnostic imaging and scanning use technology to capture an image or some other kind of representation of the inside of a person’s body. For people who may have CD, these techniques can be used to analyze parts of the body outside of the digestive tract, as well as parts of the digestive tract that cannot usually be reached by endoscopy procedures.

view references
  1. Wilkins T, Jarvis K, Patel J. Diagnosis and management of Crohn's disease. Am Fam Physician. 2011;84:1365-1375.
  2. Crohn’s and Colitis Foundation of America. Diagnosing and Managing IBD Available at http://www.ccfa.org/resources/diagnosing-and-managing-ibd.html . [Accessed 10/02/1.]
  3. Safar B, Sands D. Perianal Crohn’s disease. Clin Colon Rectal Surg. 2007;20:282-293.
  4. Lichtenstein GR, Hanauer SB, Sandborn WJ; Practice Parameters Committee of American College of Gastroenterology. Management of Crohn's disease in adults. Am J Gastroenterol. 2009;104:465-483.
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