Diagnosis and tests for ulcerative colitis

Diagnosis and tests for ulcerative colitis

Suspected UC - weeks of bloody, mucus-filled diarrhoea - is confirmed by looking at the colon, not by guessing from symptoms. The workup has a clear order.

1. Rule out infection first. Bloody diarrhoea can come from amoebiasis, shigella, TB of the gut and other infections - common in India and treated completely differently. Stool tests (microscopy, culture, sometimes PCR) come first. This step is why self-medicating "colitis" without testing is dangerous.

2. Blood tests:

• Haemoglobin - chronic blood loss causes anaemia
• CRP and ESR - inflammation markers that track disease activity
• Albumin - low levels signal severe disease
• General health screen before starting immune medicines

3. Colonoscopy with biopsy - the definitive test. A flexible camera examines the entire colon. UC shows continuous inflammation starting from the rectum; biopsies under the microscope confirm the diagnosis and exclude other causes. Sigmoidoscopy (examining the lower colon) sometimes suffices initially.

4. Faecal calprotectin - a stool marker of gut inflammation, useful to distinguish UC (high) from IBS (normal) and to monitor flares without repeating colonoscopy.

5. Imaging in specific situations: CT or MR enterography if Crohn's disease is suspected, ultrasound in some settings; plain X-ray during severe flares to watch for toxic megacolon.

After diagnosis: once extensive UC has been present 8-10 years, surveillance colonoscopies every 1-3 years watch for precancerous changes - long-standing inflammation raises colon cancer risk, and surveillance catches it early.

What diagnosis is NOT: a blood test alone, a sonography report, or a clinical hunch. No scan substitutes for colonoscopy plus biopsy.

Remember: stool tests to exclude infection, blood tests for severity, colonoscopy with biopsy to confirm - and calprotectin and surveillance scopes to monitor over the years.

Ayurvedic view (interpretive)

Traditional diagnosis reads stool, pulse and symptoms - useful for assessing state, but it cannot see the mucosa or take a biopsy. Definitive diagnosis of UC belongs to endoscopy; there is no substitute.