Preparing for Your GI Appointment: Questions to Ask Your Gastroenterologist

What to Bring to Every Appointment

Good appointments start with preparation. Bring the following:

• Current medication list — all IBD medications (dose, frequency, start date), all other medications and supplements. Many patients don't realize drug interactions are relevant to their GI care.
• Symptom log — even a rough log of stool frequency, pain level, fatigue, and any rectal bleeding over the past 2–4 weeks is more useful to your GI than memory-based reporting. A simple note in your phone works.
• Prior labs and imaging — particularly fecal calprotectin, CRP, and most recent scope reports. If you haven't received copies of your scope reports and biopsies, request them — you're entitled to them.
• Questions written in advance — ranked by priority. You may not get to all of them. Lead with the most important.

Questions About Your Disease Status

Assess objectively, not just symptomatically

One of the most common gaps in IBD follow-up is conflating "feeling okay" with "disease controlled." Asymptomatic IBD can still have active mucosal inflammation, and the damage accumulates. Ask your GI these questions:

• "What is my current inflammatory burden?" Ask for your latest fecal calprotectin and CRP values — not just whether they're "normal" but what the trend is. Fecal calprotectin below 250 µg/g generally correlates with mucosal remission; levels above 250 suggest active inflammation even with minimal symptoms.
• "When was my last scope and what did it show?" If it's been more than 1–2 years and your disease has been active, mucosal assessment may be overdue. Symptoms underestimate endoscopic disease activity in approximately 30% of IBD patients.
• "Am I in deep remission — both clinical and endoscopic?" Current guidelines define the treatment target as deep remission. Clinical remission alone (no symptoms) is an intermediate goal, not the end goal.
• "Do I have any strictures, fistulas, or perianal disease that needs assessment?" Particularly relevant for Crohn's patients — early identification of complications changes management.

Questions About Your Current Treatment

Is your regimen optimized?

Many IBD patients are on treatments that are suboptimally dosed or that have been outgrown by evidence. Ask:

• "Have my biologic drug levels been checked?" Therapeutic drug monitoring (TDM) — checking trough levels and anti-drug antibodies — is standard for anti-TNF agents. Low drug levels with high antibodies suggest immunogenicity; low levels without antibodies suggest underdosing. Both are actionable. If you're on infliximab or adalimumab and haven't had drug levels checked, ask why.
• "Am I on the right combination of medications?" If you're on an anti-TNF, ask whether combination with an immunomodulator (azathioprine, methotrexate) has been considered. Combination therapy reduces immunogenicity and can extend biologic durability — the SONIC trial showed significantly higher remission rates with combo therapy vs. monotherapy.
• "Is there a reason I'm on corticosteroids rather than optimizing my maintenance therapy?" If you've been on steroids for more than 3 months or had more than two courses in a year, this warrants a direct conversation about escalation.
• "Is my 5-ASA doing anything?" Relevant specifically if you have Crohn's disease — where evidence for 5-ASA is weak. You may be taking a medication with no evidence of benefit for your disease type.

Questions About Monitoring and Preventive Care

Long-term surveillance that often falls through the cracks

IBD management involves surveillance well beyond inflammation control. These are frequently under-addressed in routine follow-ups:

Questions If You're Not Responding to Treatment

How to have the escalation conversation

If your disease is active despite current therapy, these questions open the escalation conversation:

• "What defines treatment failure in my case, and have I reached that threshold?" Ask for objective criteria — not just symptom-based assessment.
• "What is the next step in my treatment algorithm, and what are the options?" You should understand whether the plan is dose optimization, adding a combination agent, switching within class (e.g., anti-TNF to anti-TNF), or switching mechanism (anti-TNF to anti-integrin or anti-IL).
• "Should I be referred to an IBD specialist or IBD center?" General gastroenterologists manage IBD well, but complex or refractory cases benefit from subspecialty IBD expertise. Asking is appropriate.
• "Is there a clinical trial I qualify for?" Refractory patients may be eligible for trials of emerging therapies — your GI may not mention this unless you ask.
• "Have you consulted with a colorectal surgeon about my case?" Surgical evaluation is appropriate in specific situations (medically refractory UC, complicated Crohn's with strictures/fistulas). A surgical consultation doesn't mean surgery — it means understanding all options.

Questions About Diet and Lifestyle

Get your GI's input — not just online communities

• "Should I work with a registered dietitian who specializes in IBD?" IBD-specific dietitian guidance is different from general nutrition advice. If your GI doesn't have someone to refer you to, the Crohn's & Colitis Foundation has a practitioner directory.
• "Are there specific dietary approaches with evidence for my disease type and severity?" Frame it around your phenotype — CD vs. UC, disease location, current treatment level, and whether you're in remission or active disease.
• "What supplements should I be taking, and are there any interactions with my medications?" Specifically ask about vitamin D, iron, B12, calcium — and whether your current levels are adequate.
• "How does exercise affect my IBD?" Evidence supports moderate aerobic exercise for reducing inflammation, improving fatigue, and supporting mental health in IBD. Ask whether your current activity level is appropriate for your disease state.

How to Frame Difficult Conversations

Some of the most important conversations in IBD care don't happen because patients don't know how to raise them. Scripts help:

• If you feel undertreated: "I've been reading about treat-to-target strategies and deep remission. I want to understand whether my current plan is targeting mucosal healing, not just symptom control. Can we review that?"
• If you want to understand your options: "Can you walk me through the evidence for the options at my stage of disease? I want to understand the tradeoffs before we decide on next steps."
• If you want a second opinion: "I'd like to see an IBD specialist to make sure I'm not missing any options. Can you provide a referral, or is there someone you'd recommend?"
• If you're concerned about a medication's risks: "I've read about [specific risk] with [medication]. Can you help me understand my personal risk level and how that factors into the decision?"