Table 3. Basic diagnostic evaluation for patients with suspected ulcerative colitis or Crohn’s disease as performed in the author’s university hospital outpatient practice.* The evidence levels and recommendation grades given are those of the ECCO Consensus (4, 7).
| Directed diagnostic technique | Ulcerative colitis | Evidence level and recommendation grade | Crohn’s disease | Evidence level and recommendation grade |
| History | Yes | EL 5, RG D | Yes | EL 5, RG D |
| Onset of manifestations, blood/mucus in stool, tenesmus, fecal incontinence, nocturnal diarrhea, travel and dietary history, bowel infections, use of NSAID, cigarette smoking, family history of CD or UC, appendectomy status | ||||
| Current findings | Yes | EL 5, RG D | Yes | EL 5, RG D |
| Pulse, BP, temperature, weight, height, BMI, abdomen, inspection of the perineum, digital rectal examination, examination for extra-intestinal manifestations (eyes, skin, joints, muscles) | ||||
| Laboratory tests | Yes | EL 5, RG D | Yes | EL 5, RG D |
| Electrolytes, urea, creatinine, complete blood count, ESR, liver enzymes, bilirubin, alkaline phosphatase, transferrin, ferritin, vitamin B12, folic acid, CRP, urinalysis | except for CRP and ESR | except for CRP, EL 2 RG B | ||
| Stool tests | Yes | Yes | EL 5, RG D | |
| Stool testing for bacterial organisms and resistance, C. difficile, lactoferrin or calprotectin | C. diff. EL 4, RG C | except for C. diff. EL 2, RG B | ||
| Calprotectin EL 2b, RG B | ||||
| Endoscopy | ||||
| EGD with biopsies | No | Yes, if symptomatic | EL 5, RG A | |
| Colonoscopy with ileoscopy and stepwise biopsy | Yes | EL 5, RG D | Yes | EL 1b, RG A |
| Imaging studies | ||||
| Ultrasound of the abdomen and bowel | Yes | EL 3, RG C | Yes | EL 1a, RG A |
| Extended small bowel diagnostic testing (conventional or CT/MR-Sellink) | No | Yes | EL 1b, RG A | |
| Search for extra-intestinal complications (US, CT, MRI) | Yes, if suspected | EL 2b, RG B | Yes, if suspected | EL 1c, RG A |
| Search for fistulae or abscesses (US, CT, MRI) | Yes, if suspected | EL 1c, RG A | ||
| Capsule endoscopy (WCE) | No | Yes, if terminal ileum normal or not visualizable, or if other imaging studies are negative | EL 2, RG B | |
| Virtual colography | No | EL 4, RG C | No | |
| MRCP | If PSC is suspected | If PSC is suspected | EL 2a, RG B | |
| ERC(P) with balloon dilatation | If PSC is present with dominant strictures | If PSC is present with dominant strictures | ||
| Consultation or collaborative treatment with other medical specialties | When indicated | When indicated | ||
| Surgery, rheumatology, dermatology, ophthalmology, gynecology, urology |
*There is no gold standard for diagnostic testing (ECCO, EL 5, RG D). This list is intended as an orientation for the reader and no claim of completeness is made. For certain patterns of disease involvement, in the presence of complications, or before certain types of treatment, other diagnostic techniques can and should be used.
ECCO, European Crohn’s and Colitis Organization; NSAID, non-steroidal anti-inflammatory drug;
CD, Crohn’s disease; UC, ulcerative colitis; BP, blood pressure;
BMI, body-mass index; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; C. diff., Clostridium difficile;
EGD, esophagogastroduodenoscopy; US, ultrasonography; CT, computerized tomography; MRI, magnetic resonance imaging;
WCE, wireless capsule endoscopy; MRCP, magnetic resonance cholangiopancreaticography;
ERC(P), endoscopic retrograde cholangio(pancreatico)graphy; PSC, primary sclerosing cholangitis