Considerations for undiagnosed patients
Diagnostic tests, procedures, and/or imaging recommended when diagnosing IBD
No single test can diagnose or rule out IBD
Recommended tests and procedures
ACG recommendations
The American College of Gastroenterology (ACG) recommends a variety of laboratory testing and imaging for both CD and UC, including evaluation for inflammation, anemia, and fecal pathogens.
CBC and inflammation markers
Primary care clinicians may consider ordering a complete blood count (CBC), as anemia and elevated platelet count are commonly seen in patients with CD. Nonspecific inflammatory markers such as C‑reactive protein (CRP) and erythrocyte sedimentation rate (ESR) may also be elevated.
Small bowel imaging
Should be performed as part of the initial diagnostic workup for CD as well, particularly for patients with obstructive symptoms.
Fecal calprotectin testing
Use in primary care
Studies have evaluated the use of fecal calprotectin testing in primary care settings.
Indicator of inflammation
Fecal calprotectin serves as an indicator of intestinal inflammation.
High sensitivity and a high negative predictive value
A normal fecal calprotectin level suggests a low likelihood of IBD, while positive results suggest the need for further evaluation by GI/IBD specialists.
Limitations
Not appropriate for individuals with a high likelihood of IBD based on history and physical examination, as false negatives can occur and may result in a delay in diagnosis.