Table of ContentsView AllTable of ContentsOverviewEvaluationLab TestsEndoscopic TestsBiopsyImagingNext in Ulcerative Colitis GuideHow Ulcerative Colitis Is Treated
Table of ContentsView All
View All
Table of Contents
Overview
Evaluation
Lab Tests
Endoscopic Tests
Biopsy
Imaging
Next in Ulcerative Colitis Guide
An ulcerative colitis diagnosis may involve several types of tests, including labs, endoscopy, and then eventually a colonoscopy or sigmoidoscopy. A biopsy can help confirm the diagnosis, but each step of the process helps to rule out other conditions that present the same symptoms as those associated with ulcerative colitis (UC).
During these diagnostic tests, your healthcare provider will look for inflammation in the colon. They will also look at how much of the colon is affected. The process of receiving a diagnosis for this condition can be overwhelming. So, it is helpful to understandulcerative colitisdiagnostic procedures before you go through them.
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How Do Doctors Diagnose Ulcerative Colitis?
Diagnosing ulcerative colitis may take several steps. When the signs and symptoms seem to point towards this condition, a person is usually referred to agastroenterologist. A gastroenterologist is a specialized healthcare provider who treats digestive system disorders.
Conditions that cause similar symptoms will be ruled out during the diagnostic process. The testing might start with less invasive labs (such as stool and blood tests) before moving on toendoscopy.A biopsy performed during an endoscopic procedure can help provide final confirmation of ulcerative colitis.
Usually, ulcerative colitis is diagnosed with a colonoscopy or a sigmoidoscopy. In these procedures, the healthcare provider can see inside the colon and take samples of tissue for testing. Knowing how much inflammation is present and how much of the colon is affected is important in making treatment decisions.
Evaluation and Review of Symptoms
Ulcerative colitis is an immune-mediated condition that causes inflammation. It primarily affects thelarge intestineand therectum, causing ulcers in the intestinal lining, which may bleed. It can also cause other complications outside of thedigestive system. It is one form of a group of conditions calledinflammatory bowel disease (IBD).
The term “colitis” simply refers to the inflammation of the colon’s lining. Colitis can be chronic or acute and can occur for various reasons, including infection, radiation, or a response to medication.Ulcerative colitis, on the other hand, is a chronic inflammatory bowel disease that stems from an abnormal autoimmune response.
Symptoms ofdiarrhea,bloody stools, weight loss, abdominal cramps or pain, and an urgent need to use the toilet may be what leads a person tosee a healthcare provider. When you first see a provider, you will provide a detailed medical history and get a physical exam. You will also go over the symptoms that caused your concern.
Lab Tests: Blood and Stool
The results of lab tests aren’t used to diagnose ulcerative colitis alone. Instead, these tests can rule out other conditions that have symptoms similar to ulcerative colitis. In addition, they can give more information about theeffectsthat ulcerative colitis may have on the body (such as causing inflammation and blood loss).
Blood Tests
The workup for ulcerative colitis may involve many different blood tests. This can include:
Stool Tests
Stool tests are used in the diagnostic process and during the management of UC to measure inflammation. These tests alone aren’t used to diagnose ulcerative colitis; instead, they support the diagnosis and determine the severity of the condition.
A stool sample is collected and sent for testing for an infection or other signs of IBD.
During diagnosis, a stool test might be used to rule out an infection. Some infections can cause symptoms that are similar to ulcerative colitis.
In addition, people with IBD may be at higher risk for having certain bowel infections, such asClostridioides difficile(formerlyClostridium difficile) (C. diff)or cytomegalovirus.
Endoscopic Procedures
Endoscopicprocedures are used to look inside the digestive system. There are several different types. A healthcare provider may order one or more of these tests during the diagnostic process to see the large intestine or other parts of the digestive system.
Colonoscopy
Acolonoscopyis used to see the inside of the large intestine. Because ulcerative colitis affects this part of the digestive system, this test can give important information. It may be used to diagnose ulcerative colitis when a healthcare provider sees signs of the condition (such as ulcers) in the colon.
Before your colonoscopy, you will go through test prep in which you clean stool out of the colon.Colonoscopy prep, also called bowel prep, is performed on the day before the procedure.
How a Colonoscopy Is Performed
During the course of a colonoscopy, biopsies (small pieces of tissue) will be taken from various parts of the colon and sent to a lab for testing. The results of these tests can help in making the diagnosis of ulcerative colitis.
The different types of ulcerative colitis include:
Sigmoidoscopy
Asigmoidoscopyis similar to a colonoscopy in that it involves inserting a special tool with a light and a camera on the end into the rectum. The difference is that this test is used to see just the rectum and the first section of the colon (the sigmoid colon).
This test may be done in the healthcare provider’s office without a prep or anesthesia. Some providers may ask people to prepare ahead of time with an enema or another method to clean out the rectum.
The test will be done as quickly as possible. People may feel discomfort if it’s not done using sedation. Talk over any concerns about the procedure, including discomfort or pain, with your healthcare provider beforehand.
Chromoendoscopy
People with ulcerative colitis may be at risk for changes in the tissue of the colon that could lead to colon cancer. The risk of cancer increases after having the disease for more than eight years.
Chromoendoscopy is the use of a blue dye during a colonoscopy to mark areas of the colon that look like they may be undergoing precancerous changes.
Biopsies that are taken from the colon can help in diagnosing ulcerative colitis. They may also be used to rule out other diseases and conditions.
During a colonoscopy or a sigmoidoscopy, a healthcare provider will take a number of biopsies from different parts of the intestine. These will be sent to a pathologist (a physician who studies body fluids, tissues, or organs). The pathologist will examine the tissue under a microscope and with other methods.
Imaging Procedures
Other tests might be used during the diagnosis process. If ulcerative colitis is diagnosed with a colonoscopy, and there are no symptoms in the upper digestive tract, these imaging tests might not be used.
X-Ray
An X-ray may be used while looking for a diagnosis. It can not be used to diagnose ulcerative colitis. However, it is a quick, easily available test that can rule out other reasons for the symptoms.
CT scan
Acomputed tomography (CT) scanof the small intestine may be used if there are symptoms that could be from that area. In this test, X-rays are used to create an image of the structures inside the abdomen. This test can show if there are abnormalities or problems with the upper digestive system.
Contrast solution may be given with an intravenous (IV) line or in a drink. It helps the structures of the abdomen show up better on the X-ray film.
CT Enterography
A computed tomographyenterographycan be used to see the walls of the intestine. This test uses radiation, but it is less than that of a traditional X-ray.
In ulcerative colitis, the wall of the large intestine may become thickened. A thickened wall might be seen on a CT enterography.
This test may be done using contrast so the healthcare providers who look at the images can better see the organs in the digestive system.
MR Enterography
Amagnetic resonance (MR) enterographyis a test that doesn’t involve radiation. It may be used to create an image of the organs in the abdomen. This test may be done with contrast fluid via an IV and/or with a drink so the internal structures show up better on the images.
This test isn’t used to diagnose ulcerative colitis. However, it can give better images and more information than an X-ray or a CT enterography. It may be used to rule out other reasons for symptoms or to look for abnormalities like narrowed areas in the intestine.
Summary
Diagnosing ulcerative colitis will involve several different types of tests or procedures. Ulcerative colitis is usually diagnosed with a colonoscopy where biopsies are taken. Other tests might be used to rule out different reasons for symptoms or to see if there is something going on outside of the large intestine.
Because ulcerative colitis affects everyone differently, in some cases, diagnosis may take some time. This condition requires management and treatment over a lifetime, so many tests that are used during diagnosis may also be done again on a regularly scheduled, ongoing basis.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD.ACG clinical guideline: ulcerative colitis in adults.Am J Gastroenterol. 2019;114:384-413. doi:10.14309/ajg.0000000000000152Azer SA, Sun Y.Colitis. In:StatPearls. StatPearls Publishing; 2024.National Institute of Diabetes and Digestive and Kidney Diseases.Definition & Facts of Ulcerative ColitisHoltman GA, Lisman-van Leeuwen Y, Day AS, et al.Use of laboratory markers in addition to symptoms for diagnosis of inflammatory bowel disease in children: a meta-analysis of individual patient data.JAMA Pediatr. 2017;171:984–91. doi:10.1001/jamapediatrics.2017.1736Cioffi M, Rosa AD, Serao R, Picone I, Vietri MT.Laboratory markers in ulcerative colitis: current insights and future advances.World J Gastrointest Pathophysiol. 2015;6:13-22. doi:10.4291/wjgp.v6.i1.13Inflammatory Bowel Disease Group, Chinese Society of Gastroenterology, Chinese Medical Association.Evidence-based consensus on opportunistic infections in inflammatory bowel disease (republication).Intest Res. 2018;16:178-193. doi:10.5217/ir.2018.16.2.178Pathirana WGW, Chubb SP, Gillett MJ, Vasikaran SD.Faecal calprotectin.Clin Biochem Rev.2018;39:77–90Crohn’s and Colitis Foundation.The risk of colorectal cancer.Johns Hopkins Medicine.CT Enterography.Johns Hopkins Medicine.MR enterography.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD.ACG clinical guideline: ulcerative colitis in adults.Am J Gastroenterol. 2019;114:384-413. doi:10.14309/ajg.0000000000000152Azer SA, Sun Y.Colitis. In:StatPearls. StatPearls Publishing; 2024.National Institute of Diabetes and Digestive and Kidney Diseases.Definition & Facts of Ulcerative ColitisHoltman GA, Lisman-van Leeuwen Y, Day AS, et al.Use of laboratory markers in addition to symptoms for diagnosis of inflammatory bowel disease in children: a meta-analysis of individual patient data.JAMA Pediatr. 2017;171:984–91. doi:10.1001/jamapediatrics.2017.1736Cioffi M, Rosa AD, Serao R, Picone I, Vietri MT.Laboratory markers in ulcerative colitis: current insights and future advances.World J Gastrointest Pathophysiol. 2015;6:13-22. doi:10.4291/wjgp.v6.i1.13Inflammatory Bowel Disease Group, Chinese Society of Gastroenterology, Chinese Medical Association.Evidence-based consensus on opportunistic infections in inflammatory bowel disease (republication).Intest Res. 2018;16:178-193. doi:10.5217/ir.2018.16.2.178Pathirana WGW, Chubb SP, Gillett MJ, Vasikaran SD.Faecal calprotectin.Clin Biochem Rev.2018;39:77–90Crohn’s and Colitis Foundation.The risk of colorectal cancer.Johns Hopkins Medicine.CT Enterography.Johns Hopkins Medicine.MR enterography.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD.ACG clinical guideline: ulcerative colitis in adults.Am J Gastroenterol. 2019;114:384-413. doi:10.14309/ajg.0000000000000152Azer SA, Sun Y.Colitis. In:StatPearls. StatPearls Publishing; 2024.National Institute of Diabetes and Digestive and Kidney Diseases.Definition & Facts of Ulcerative ColitisHoltman GA, Lisman-van Leeuwen Y, Day AS, et al.Use of laboratory markers in addition to symptoms for diagnosis of inflammatory bowel disease in children: a meta-analysis of individual patient data.JAMA Pediatr. 2017;171:984–91. doi:10.1001/jamapediatrics.2017.1736Cioffi M, Rosa AD, Serao R, Picone I, Vietri MT.Laboratory markers in ulcerative colitis: current insights and future advances.World J Gastrointest Pathophysiol. 2015;6:13-22. doi:10.4291/wjgp.v6.i1.13Inflammatory Bowel Disease Group, Chinese Society of Gastroenterology, Chinese Medical Association.Evidence-based consensus on opportunistic infections in inflammatory bowel disease (republication).Intest Res. 2018;16:178-193. doi:10.5217/ir.2018.16.2.178Pathirana WGW, Chubb SP, Gillett MJ, Vasikaran SD.Faecal calprotectin.Clin Biochem Rev.2018;39:77–90Crohn’s and Colitis Foundation.The risk of colorectal cancer.Johns Hopkins Medicine.CT Enterography.Johns Hopkins Medicine.MR enterography.
Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD.ACG clinical guideline: ulcerative colitis in adults.Am J Gastroenterol. 2019;114:384-413. doi:10.14309/ajg.0000000000000152
Azer SA, Sun Y.Colitis. In:StatPearls. StatPearls Publishing; 2024.
National Institute of Diabetes and Digestive and Kidney Diseases.Definition & Facts of Ulcerative Colitis
Holtman GA, Lisman-van Leeuwen Y, Day AS, et al.Use of laboratory markers in addition to symptoms for diagnosis of inflammatory bowel disease in children: a meta-analysis of individual patient data.JAMA Pediatr. 2017;171:984–91. doi:10.1001/jamapediatrics.2017.1736
Cioffi M, Rosa AD, Serao R, Picone I, Vietri MT.Laboratory markers in ulcerative colitis: current insights and future advances.World J Gastrointest Pathophysiol. 2015;6:13-22. doi:10.4291/wjgp.v6.i1.13
Inflammatory Bowel Disease Group, Chinese Society of Gastroenterology, Chinese Medical Association.Evidence-based consensus on opportunistic infections in inflammatory bowel disease (republication).Intest Res. 2018;16:178-193. doi:10.5217/ir.2018.16.2.178
Pathirana WGW, Chubb SP, Gillett MJ, Vasikaran SD.Faecal calprotectin.Clin Biochem Rev.2018;39:77–90
Crohn’s and Colitis Foundation.The risk of colorectal cancer.
Johns Hopkins Medicine.CT Enterography.
Johns Hopkins Medicine.MR enterography.
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