The goal of any ulcerative colitis treatment is to help you reach both clinical remission (an absence of symptoms) and endoscopic remission (a healing of the bowel’s mucosal lining).
“People with endoscopic healing have a better chance of doing well in the longer run than those who don’t [have endoscopic healing], which is why we make it a goal,” says Adam S. Cheifetz, MD, director of the center for inflammatory bowel disease at Beth Israel Deaconess Medical Center and a professor of medicine at Harvard Medical School in Boston.
To check for clinical remission, your doctor will first ask you whether symptoms such as bleeding and urgency have resolved. Then, they might recommend one or more of the following tests to assess how your gut is healing:
Endoscopy
A doctor inserts a thin, flexible tube with a lighted camera into the anus to examine the inside of the gastrointestinal (GI) tract. Two of the most common endoscopy tests for ulcerative colitis include:
Sigmoidoscopy
The doctor examines the lower third of the colon for signs of inflammation and bleeding. This test can be performed with or without sedation.
Colonoscopy
The doctor checks the entire lining of the colon for inflammation and bleeding and precancerous or cancerous growths. You will be sedated during the procedure. Compared to a sigmoidoscopy, this test is slightly more invasive and requires more preparation. You usually have to follow a restricted, clear-liquid diet for 24 hours before a colonoscopy.
Your doctor might have recommended an endoscopy when you were first diagnosed, says Dr. Cheifetz, but repeat scopes are often recommended every one to three years to assess disease activity and check for signs of colon cancer.
Biopsy
A small piece of tissue is collected during a colonoscopy and analyzed in a laboratory. When your doctor first diagnosed you, they may have performed a biopsy to evaluate new GI symptoms. “If somebody is sick, we do biopsies to make sure there’s no concurrent infection,” says Cheifetz. Your doctor might also do a biopsy to check for precancerous growths in the colon.
C-Reactive Protein (CRP) Test
This blood test reveals how much C-reactive protein, a type of inflammatory marker, is in your blood. It’s not specific to ulcerative colitis, because CRP can be high for many reasons, but the inflammatory marker is often elevated during ulcerative colitis flares. CRP usually goes down quickly after you start taking medication, says Cheifetz. From there, the test is often repeated every 6 to 12 months.
Fecal Calprotectin Test
The doctor sends your stool sample to a lab to check for fecal calprotectin, a protein that’s often elevated in ulcerative colitis. High levels of fecal calprotectin can signal gut inflammation, which can occur when the immune system sends an influx of white blood cells into the area, releasing calprotectin.
Your doctor might have recommended this test when you were first diagnosed with ulcerative colitis and may have repeated it about three to six months later. That’s how long it usually takes for calprotectin levels to normalize, says Cheifetz. From there, your doctor might repeat this test every 6 to 12 months.
Complete Blood Count (CBC)
Computed Tomography (CT) or Magnetic Resonance Elastography (MRE) Scan
These tests provide 3D images of the inside of the colon. They can provide additional information about abnormalities spotted on a colonoscopy or serve as an alternative when a colonoscopy isn’t feasible.
A CT scan uses multiple X-rays to produce a picture. MRE uses magnetic resonance imaging (MRI) with low-frequency vibrations to create an image of the gut.
Both tests can help doctors spot and assess inflammation and ulcers in people with ulcerative colitis, research suggests.
Intestinal Ultrasound
Ultrasound helps doctors see thickening of the bowel wall, a sign of inflammation. This noninvasive test isn’t commonly used in ulcerative colitis, but some doctors are starting to use it more regularly. If the results of any of these tests suggest ulcerative colitis is flaring, your doctor might recommend further testing or adjust your treatment plan.
The Takeaway
- The goal of ulcerative colitis treatment is remission, meaning symptoms have eased and you’re showing signs of improvement on key medical tests.
- Your doctor might recommend one or more imaging or blood tests to detect signs of gut inflammation.
- If the tests suggest ulcerative colitis is not in remission, your doctor might recommend more tests or a change in medication.
Read the full article here
