Community Forum

Hi All

Just after some information as to whether Crohn's Disease (CD) or Ulcerative Colitis (UC) can be seen during a routine blood test?

I've done a bit of research and found that routine blood tests cannot diagnose CD or UC, but are good indicators on how severe the levels of inflammation / infection are during active flare ups, and whether medications are helping to subdue the diseases.

I only ask as I was recently asked to provide a stool sample to test for faecal calprotectin, which came back positive. This is the third test I had done in the last year and the results have always been around 350. I had a follow up colonoscopy about 6 months ago, as a result of the first positive calprotectin result, however everything looked healthy and the biopsies came back fine, ruling out UC. Now my doctor suspects CD, however I had a blood test taken a few days after the faecal calprotectin test and the results of the blood test was fine, apart from slightly low vitamin D levels. This recent blood test according to the nurse was the full works, and I know included vitamin B12 and D tests, magnesium levels, liver function, kidney function, and a load more including the routine tests. I've been having digestive problems for about three years now, and had numerous blood tests in that time and the only problem ever found was slightly low vitamin D results, no other problems ever found.

I'd be very grateful for any thoughts and views on this query, especially if you know whether or not active CD or UC are in fact visible on blood tests.

Reply posted for bigshorty.

If you had good health insurance which had an out of pocket maximum already met for the year, like I have, then it would be pretty easy to just ask for the scan. But since you're implying that this isn't the case, I sympathize with your hesitation. It's unfortunate that in the USA we often have to make a choice between money and health, but that's just a reality. Since it seems you have gotten a good deal of professional opinions that differ, maybe the best thing to do would be to just, go with your gut, no pun intended. If you're feeling fine for the time being, then maybe there's not much of a need to get another scan. On the other hand, if you feel like you just can't get a handle on your symptoms, then maybe it would be worth the money to pay for the scan.

Reply posted for kumputer.

Many thanks for the reply and all the information, very useful indeed, and I do appreciate your time.

At this point I thought I should mention that I did in fact have a colonoscopy about 6 months ago with biopsies taken, as a follow up to the first positive faecal calprotectin results. The results of that colonoscopy were very pleasing, the doctor performing the procedure said that my rectum, colon and terminal ileum looked very healthy and the biopsy results came back as normal. The only thing they found were internal haemorrhoids, which I have subsequently discovered could have produced positive faecal calprotectin results if they are in an inflamed state. I watched the whole colonioscopy on the TV screen and from what I remember they looked to be quite a number of haemorrhoids and they were were quite prominent. The positive colonoscopy results were the reasoning behind 2 doctors saying that it is very unlikely, if not impossible that I have an IBD. However the one other doctor that said it could be a possibility if the Crohn's is confined to the small bowel, suggests I have a small bowel MRI / CT scan to be on the safe side. I really don't know what to do, I'd rather not pay for a procedure that is looking likely will show nothing wrong, however we all need a bit of peace of mind now and again.

I generally feel slightly unwell most days, and then go through these bouts of being more ill, which I am currently having at the moment. Yet to me it feels more like an IBS attack, and from speaking to numerous people with IBD's and IBS I have discovered that IBS attacks can be just as debilitating and having an IBD attack.

I'm totally confused and really don't know what to do now, any thoughts would be very welcome.

Reply posted for bigshorty.

First disclaimer, I'm not a medical professional, but as a patient I do my best to stay as informed as possible.

I think if doctors don't strongly suspect Crohn's, then I there's probably little reason to doubt them. Making a diagnosis is all about gathering evidence. Typically, if you have multiple lines of evidence pointing in the same direction, then the more confident you can be in the accuracy of a diagnosis. It seems in your case that you only have one line of evidence pointing to the possibility of Crohn's or IBD, and that's not enough for a diagnosis in my opinion. That doesn't mean you don't have IBD. You very well could, but people who suffer from IBD mostly know that the severity of symptoms change drastically, sometimes quickly. Blood markers will typically correlate well with physical symptoms, but the best line of evidence you can have for IBD is direct observation of inflammation, meaning, a colonoscopy.

But, to be clear, if you were having bad symptoms, there's certainly no guarantee that blood markers will reflect that. It's just a decent place to start.

Good luck with how this pans out. Hopefully it's nothing to worry about, but if you're anxious, maybe you can ask for a colonoscopy for more information.

Reply posted for kumputer.

Many thanks for your reply Kumputer.

Just to clarify the points you made, you are saying that if for example I did have Crohn's Disease and was experiencing an active flare up, then it's more likely than not that signs of this flare up would be present in blood tests (particularly the one's you mentioned)?

If that is the case then I don't see how I can have signs of inflammation in my my stool tests, but not in blood tests, if it were in fact Crohn's. I also don't show the typical signs of Crohn's, I never get frequent bloody diarrhoea, I never get a fever, abdominal pain and cramping is minimal and could be anything like IBS, no anal pain or drainage, no reduced appetite or weight loss and no mouth sores. The only symptoms that could relate to Crohn's Disease for me are fatigue, which again is minimal and could be attributed to a poor diet I'm on due to experiencing a lot of food intolerances or my CFS diagnosis, and inflammation of eyes, joints and skin, although even with that symptom it is only my eye lids that cause me trouble and their not actually inflamed, they feel lumpy and twitchy a lot, certainly no reddening of the whites of my eyes as is suggested for Crohn's sufferers. I suffer with a lot of bloating and stomach and bowel churning and gurgling though, I don't know if these are typical Crohn's symptoms but from what I've researched they aren't.

There seems to be a lot of confusion with docors regarding the fact that faecal calprotectin levels for me are raised (>350 result), but there is no sign of inflammation in my blood tests taken at the same time. I've had all the routine investigations, tests and biopsies done and nothing has been found, other than the raised calprotectin results in my stool samples. I've had 3 doctors give me 3 different conclusions, one saying there is a chance it could still be Crohn's, another saying it is very unlikely and another saying definitely not Crohn's Disease.

I'd be very grateful for yours, and anybody else's thoughts and views on this.

Reply posted for bigshorty.

As you said, blood tests can be used to look for markers of inflammation. Here are some that I know of:

- High C-Reactive Protein (over 10 mg/L)
- High Erythrocyte Sedimentation Rate (over 20 mm/h)
- High white blood cell count

For me personally, the marker that correlates best with how badly I'm feeling is C-Reactive protein. But no diagnosis can be made based on a blood test. And there's not always a direct connection.

Reply posted for charbs.

Thank you so much for the reply, although I think you might have misinterpreted my query. I'm happy with a diagnosis to be made by an MRI / CT scan, but my query is more about how an active Crohn's Disease flare up can affect routine blood tests. Will routine blood tests show any signs of an active Crohn's flare up?
Insurance isn't a problem thankfully.

Reply posted for bigshorty.

There is a company called Prometheus that can diagnose Crohn’s thru a blood test.  It is very expensive.  Hope you have good insurance.