Those who live with Crohn’s disease know that at times symptoms become more severe, which is known as a Crohn’s flare-up. There is no specific test to determine if a worsening of symptoms is a flare-up, so doctors look at the patient’s symptoms and order tests to get a better idea. The process is similar to the methods employed by Sherlock Holmes, piecing many clues together to figure out a problem. Aside from procedures such as upper endoscopies and colonoscopies to look at the intestines, blood tests and fecal tests can also indicate inflammation.
Blood tests can indicate inflammation
Doctors will typically order three blood tests to look for infection, anemia, and inflammation. A complete blood count is useful to check for infection and anemia. Blood tests that can indicate inflammation include c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
C-reactive protein is produced by the liver in response to inflammation in the body. Levels of CRP can be elevated when an infection is present, during active inflammatory bowel disease, and in conditions such as arthritis. Though this test is imprecise, it’s a good place to start when a doctor is investigating a flare-up. The ESR test is similar to a CRP test, and also indicates inflammation in the body: the higher the rate, the greater the inflammation. However, while these tests show the presence of inflammation, they do not pinpoint its location.
What if blood test results are insufficient?
Recently, I visited my gastroenterologist because I have been experiencing more severe gastrointestinal (GI) symptoms for a couple of weeks. I thought that I was having a Crohn’s flare-up. My doctor would usually order the CRP and ESR tests to look for inflammation, but those results can be misleading for a couple of reasons. In April, I had total shoulder replacement surgery, and I was also getting over an asthma flare-up. Both of these factors can elevate inflammatory markers. My doctor wanted to ascertain if my Crohn’s was causing my GI symptoms or if it was something else.
A couple of years ago, I developed secondary adrenal insufficiency because of long-term use of corticosteroids. I initially took the steroid prednisone for my asthma and occasionally increased the dose for Crohn’s flares. When someone takes artificial steroids, or corticosteroids, for a prolonged period, adrenal insufficiency — in which the adrenal glands no longer produce natural cortisol — can sometimes occur. I take a low dose of steroids to compensate for my lack of cortisol. My GI doctor was worried that my prednisone dose had been tapered down too quickly from the asthma flare and was possibly too low because adrenal insufficiency can also cause GI symptoms.
Since we couldn’t rely on the blood tests because of many factors that could elevate inflammation markers, my doctor ordered a different test: a calprotectin test.
Another test to find the inflammation source
For people like me, in which the CRP and EST tests might not be reliable to find out if their Crohn’s disease is flaring up, a test to check calprotectin levels in a stool sample is a helpful alternative. Raised calprotectin levels indicate active inflammation in the intestines. Since the blood tests looking for inflammation wouldn’t be helpful in my case, this test would help to determine if a Crohn’s flare-up was the culprit behind my symptoms.
When I received my results, my calprotectin levels were extremely high. This result informed my doctor that I was having a Crohn’s flare-up, and I started treatment straightaway. Although I don’t particularly like doing stool tests, this one was valuable as it helped to pinpoint that my symptoms were caused by my Crohn’s flaring up.
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