# How can blood test results show no active inflammation but when a colonoscopy is performed, there is active inflammation



## David (Dec 20, 2013)

A member recently asked, 


> How can blood test results show no active inflammation but when a colonoscopy is performed, there is active inflammation.  Is this common?


Tolulope O. Falaiye, M.D. of the Penn State Hershey Inflammatory Bowel Disease Center took time out of her busy schedule to answer this question. A little about Dr. Falaiye:





Tolulope O. Falaiye, MD is a pediatric gastroenterologist Hershey/Penn State IBD Center.

In regards to the question, Dr. Falaiye stated:



> Inflammation can be measured by different markers.  The markers we usually use for IBD are C reactive protein (CRP) and erythrocyte sedimentation rate (ESR). CRP is used most often because it is more sensitive. CRP increases and decreases quickly, while ESR takes longer to show changes.  CRP seems to be a better marker for Crohn’s disease than ulcerative colitis. Fecal calprotectin, platelet count and white blood cell count can also be markers of inflammation.  None of these are specific to Inflammatory Bowel Disease unfortunately.  In some patients the ESR will be high and CRP will be normal, even when there is inflammation on endoscopy. Research is being done to understand why this happens.  One idea is that in UC, inflammation is just in the lining while in Crohn’s disease inflammation goes deeper.  Other research is focusing on the genes for CRP and how they might be different in different people.  These are just a few ideas scientists have. We don’t know which is the correct idea yet, but most likely it will be a combination of the ideas.


Thank you to Dr. Falaiye for her time and expertise!


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## Lady Organic (Mar 31, 2014)

In my case, blood markers are abnormal only when inflammation is severe. When I am early in a flare or even now with mild arthritis, everything is normal in my blood tests. same for a friend with rheumatoid arthritis. Mild inflammation does not show up in blood results for some people.


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## LewisS (May 10, 2014)

This is what I'm most worried about. I am getting blood tests done on Monday and I have a feeling they will come back normal and I'll be left undiagnosed or be told I have IBS. :/


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## Andy1982 (May 10, 2014)

I had a ct scan last week and showed no sign of crohns but yesterday got bloods done and crp was at 36 and I had cramping,colicky pain so have been put on pred along with my mercaptopurine.
I still can't understand this illness!!


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## nogutsnoglory (May 10, 2014)

Thank you for your response Dr. In my case I can be shelter inflamed but it doesn't reflect in my blood tests. I guess everyone is different.


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## Daisy123 (May 10, 2014)

Inflammation rarely features on my blood tests. It usually takes a colonoscopy to diagnose. No idea why.


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## Ness1993 (May 10, 2014)

My blood tests asually always come back normal (unless im so bad i have to go to hospital). But my colonoscopy showed inflammation and thats how i got my diagnosis of UC.


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## Mrs_R (May 13, 2014)

Really interesting thread here, and a very informative answer thank you. I have had so many blood tests in the last 10 years and the only thing that has ever come back abnormal is my Vitamin D levels. I never showed any markers for inflammation and even a colonoscopy came back with no evidence. It was only through an MRI that they found my Crohn's. It's such a complicated disease but I remain hopeful that new facts are being discovered all the time


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## deb8997 (May 13, 2014)

I think my daughter has the opposite. she is feeling great no signs of a flare up but all the blood and fecal tests came back off the charts. she is on 6 mp & Pentasa and was slowly taken off prednisone. ever since the taper off of prednisone her numbers got high. so now another colonoscopy to see whats going on..


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## jojoshabadoo (Jul 27, 2014)

All this support one of the most wish washy diagnoses in medicine. 

A colonoscopy CAUSES inflammation so maybe thats why or because of the colon evacuation the night before

To illustrate, if you take a knife and superficially cut your arm it gets red and slightly edematous while healing. thats inflammation as well, dead cells from the scrape are cleared and destroyed (they don't magically disappear, the body breaks down and clears it). The physical sign is inflammatory skin changes, the symptom is mild transient pain. 

Its a miraculous and daily phenomenon in our body and all living things, something to be respected and not seen as a disease. Without inflammation we would not exist as we would have been overcome by infectious microbes and viruses, they are killed by immune system and there by products degraded and cleared.

Thats why this disease is nonexistant for most with it if any, the criteria is confounded by diagnostic procedures and systemic inflammatory markers with basically no specificty like the lady doc said

Münchhausen by proxy for these poor kids i bet


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## pete b (Sep 25, 2014)

Currently in flare for 5 months with normal blood results and been discharged 4 times from hospital and the Dr there saying IBS but I told them it crohns as I get all the same symptoms when I flare so I went and spoke to the my crohns consultant and went for capsule endoscopy and it showed ulcers in the small intestine


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## sleepallday (Sep 25, 2014)

After being diagnosed with Crohn's Disease in May, I was put on Budesonide and Azathioprine. I've felt quite bad since being treated, although each of my fortnightly blood tests came back normal. My specialist was happy with my final inflammation markers though because of my symptoms, gave me a referral to have an MRE.
It turns out that I have had ongoing inflammation an damage (meaning my medications haven't been working particularly well for me..) so we are now looking at surgery.

If you feel as though there is something still not quite right, make sure to point it out to your specialist. I'm very lucky in the fact that I have a not only very bright but caring and understanding Dr, though I know not every patient is as lucky.
Please remember as it has been mentioned previously, there is still a lot unknown about IBD and the individual differences can be extraordinary. For this reason Doctors can often find us to be trickier cases but you know your body better than anyone else does. Speak up and get the care you deserve.

If anyone finds out further information as to why it doesn't always show in blood tests, I would love to know. 

Wishing everyone the best! xx


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## wellen1981 (Sep 28, 2014)

Lara said:


> After being diagnosed with Crohn's Disease in May, I was put on Budesonide and Azathioprine. I've felt quite bad since being treated, although each of my fortnightly blood tests came back normal. My specialist was happy with my final inflammation markers though because of my symptoms, gave me a referral to have an MRE.
> It turns out that I have had ongoing inflammation an damage (meaning my medications haven't been working particularly well for me..) so we are now looking at surgery.
> 
> If you feel as though there is something still not quite right, make sure to point it out to your specialist. I'm very lucky in the fact that I have a not only very bright but caring and understanding Dr, though I know not every patient is as lucky.
> ...



Hi are you aware of Prof Tom Borody and have you read up on his work? He is local to you and from what i have gathered research-wise, he seems to be the most ahead in Western society regarding Crohns.


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## sleepallday (Oct 1, 2014)

wellen1981 said:


> Hi are you aware of Prof Tom Borody and have you read up on his work? He is local to you and from what i have gathered research-wise, he seems to be the most ahead in Western society regarding Crohns.


Hello! 

No I haven't but I've heard him mentioned previously. I will definitely have a read into his work and if possible, get in contact with him too. 
Thank you actually for reminding me to do so, living so close by it'd be silly for me to not utilize the resources.


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## wellen1981 (Oct 11, 2014)

Lara said:


> Hello!
> 
> No I haven't but I've heard him mentioned previously. I will definitely have a read into his work and if possible, get in contact with him too.
> Thank you actually for reminding me to do so, living so close by it'd be silly for me to not utilize the resources.


Posting this for you and anyone else...

It's the facility he runs and this actual link is probably the best, shortest, clearest info on Crohn's I have found online and helps to pass on to non-sufferers so they understand the condition eg family members etc

http://www.cdd.com.au/pages/disease_info/crohns_disease.html


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## Jay Woodman (Oct 12, 2014)

@wellen I always find referral to information sources on CD most helpful!


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## leber (Jun 6, 2015)

Oh, I didn't know it.
I always check the iron concentration, CRP,leucocyte and some other value on my blood test with my doctor. My next colonoscopy will be in the next year(after 4 years).


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## teeny5 (Jun 8, 2015)

Interesting...I have been in remission according to blood tests and symptoms. Will be interesting to see what comes up on my colonoscopy next month. My GI said I needed one to see what's going on...I thought it was odd since my tests were normal. He said there could still be inflammation and damage in there.


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