Exams and Tests

Your child's evaluation will start with a medical interview and physical examination. You will be asked questions about your child's:

• symptoms and how they started,
  
  
• current medical problems and those in the past,
  
  
• current medications now and those in the past,
  
  
• family medical problems,
  
  
• diet,
  
  
• habits, and
  
  
• lifestyle.

The physical examination will include careful touching of the abdomen and possibly of the rectum. The child's physical growth and sexual development will be assessed. At any time during the evaluation, you may be referred to a gastroenterologist (a doctor who specializes in diseases of the digestive tract).

Lab tests

There is no lab test that can absolutely confirm that your child has Crohn's disease. Blood tests may be done to look for evidence of the disease, such as inflammation, anemia, or nutritional deficiencies. A stool sample may be collected to look for blood or signs of infection.

Imaging studies

Your child may undergo imaging studies to detect the extent of the disease and any complications that may have developed.

• Barium contrast studies: This consists of a series of x-rays taken after your child drinks a contrast material containing a chalky substance called barium. The barium allows the intestine to show up better than on a plain x-ray. Barium studies are very useful in defining the nature, distribution, and severity of the disease. Barium studies may include an "upper GI series" (x-rays of the upper part of the digestive system) and a "small bowel follow-through" (x-rays of the small intestine).
  
  
• Barium enema: This works on the same principle as the barium contrast studies of the upper digestive system, but the barium is introduced into the lower digestive tract through the rectum. This test is occasionally done to see whether the colon and rectum are involved, and to what extent.
  
  
• CT scan or, in some cases, ultrasound is helpful in assessing complications outside of the intestine, such as fistulas, an abscess, or abnormalities of the liver, bile duct, or kidneys. MRI may be used instead.
  
  
• Radionuclide-tagged white blood cell scan can be very useful in defining the location and extent of the disease.

Endoscopy is always necessary to make a definite diagnosis.

• Endoscopy involves inserting a thin tube with a light and a tiny camera at the end into a body cavity or organ. The camera transmits pictures of the inside of the organ so that the doctor can see inflammation or bleeding or other signs of disease.
  
  
• Both the upper and the lower parts of the digestive tract can be examined endoscopically. Endoscopy of the lower part of the digestive tract is called colonoscopy. Endoscopy of the upper digestive tract is usually called upper endoscopy.
  
  
• In both cases, the doctor can use the endoscope to take a biopsy. A biopsy is a tiny sample of tissue taken from the superficial lining on the inside of the digestive tract. These tissues are examined under a microscope by a pathologist (a doctor who specializes in diagnosing diseases by examining tissues and cells in this way).

Endoscopic retrograde cholangiopancreatography (ERCP) is helpful for both diagnosis and treatment in people who have Crohn's disease of the pancreas or bile ducts.

Staging

Medical professionals who care for people with Crohn's disease use various systems for tracking symptoms and responses to treatment over time. The Pediatric Crohn's Disease Activity Index (PCDAI) was developed for children and adolescents in 1990 from a similar scale used for adults. Your child's health care provider may use this scale to find patterns in disease severity and adjust treatment.