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Colitis: Types, Symptoms, Causes, Tests and Treatment

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Friendly doctor pointing to a drawing of the colon on a screen for a smiling patient, with a stool sample container, blood test tubes, rice and bananas

⚕️ This article is for informational purposes only and does not replace medical advice. Always consult your doctor to interpret your results.

Colitis is inflammation of the colon, the large intestine. It is not one disease but a sign shared by several conditions: ulcerative colitis, microscopic colitis, ischemic colitis (poor blood flow), infections such as C. difficile, reactions to medicines, and allergic colitis in babies. Typical symptoms are diarrhea, belly pain or cramps, an urgent need to pass stool and, in some types, blood or mucus in the stool.

Colitis is diagnosed with stool tests (infection screening, fecal calprotectin), blood tests (blood count, CRP, albumin, kidney function) and, in most lasting cases, a colonoscopy with biopsies. Treatment depends entirely on the type: antibiotics for C. difficile, budesonide for microscopic colitis, supportive care for most ischemic colitis, and long-term anti-inflammatory medicines for ulcerative colitis.

Key takeaways

  • "Colitis" means inflammation of the colon; the cause decides the treatment, so finding the type comes first.
  • About 2.39 million Americans have inflammatory bowel disease (ulcerative colitis or Crohn's disease), and about 700,000 have microscopic colitis.
  • Stool tests rule out infection; a fecal calprotectin below 50 µg/g makes inflammatory bowel disease unlikely in a person with diarrhea.
  • Colonoscopy with biopsies confirms ulcerative and microscopic colitis; microscopic colitis looks normal to the eye and is seen only under the microscope.
  • New medicines (IL-23 blockers, S1P receptor modulators) and 2026 guidance on C. difficile have widened treatment choices.

What is colitis?

When the lining of the colon is inflamed, it may bleed or make mucus, which explains the diarrhea, urgency and cramps. Cleveland Clinic describes colitis as inflammation of the colon that can be temporary, for example after an infection, or chronic and lifelong.

Some forms heal in days; others are chronic inflammatory bowel diseases (IBD) with flares and remissions. Because symptoms overlap, the same first tests serve all types.

What are the different types of colitis?

Ulcerative colitis

Ulcerative colitis is a chronic IBD in which abnormal immune reactions cause inflammation and ulcers in the lining of the large intestine. MedlinePlus explains that it starts in the rectum and may spread upward without skipping areas. It can be limited to the rectum (ulcerative proctitis), reach the left side of the colon (left-sided colitis), or extend further (extensive colitis or pancolitis). The NIDDK estimates that 600,000 to 900,000 people in the US have it, most often starting between ages 15 and 30. Our news piece on the ulcerative colitis blood test covers new antibody markers.

Microscopic colitis

Microscopic colitis causes chronic, watery, non-bloody diarrhea, often at night. The colon looks normal during colonoscopy; the inflammation is visible only in biopsies. There are two forms: lymphocytic colitis (extra white blood cells in the lining) and collagenous colitis (a thickened collagen layer). The NIDDK estimates that about 700,000 Americans have it; the average age at diagnosis is 60 to 65, and it is three to nine times more common in women. Unlike ulcerative colitis, it does not increase colon cancer risk.

Ischemic colitis

Ischemic colitis happens when blood flow to part of the colon drops, often in older adults with hardened arteries. MedlinePlus notes that pain usually comes first, followed by rectal bleeding. Most cases are mild and heal with supportive care, but some need surgery (see the treatment section).

Infectious colitis, including C. difficile

Bacteria, viruses and parasites can inflame the colon. Clostridioides difficile (C. diff) is the best known: the CDC estimates almost half a million infections in the US each year, and people are up to 10 times more likely to get it while taking an antibiotic and in the month after. C. diff colitis, also called pseudomembranous colitis, causes watery diarrhea, often 5 to 10 times a day, cramps and fever. Other germs are found with a stool culture or an ova and parasites stool test.

Drug-induced colitis and immune checkpoint inhibitor colitis

Several medicines can trigger colitis. The NIDDK links microscopic colitis to NSAIDs, proton pump inhibitors, SSRI antidepressants, hormone therapy, beta blockers and statins. Cancer immunotherapy with immune checkpoint inhibitors (such as anti-PD-1 or anti-CTLA-4 drugs) can cause immune-related colitis; a 2023 review notes that up to two-thirds of patients on these drugs have some immune-related side effect. In a 2026 study of 10,260 adults on these drugs, concurrent antibiotics (hazard ratio 2.72) and NSAIDs (1.50) were the strongest risk factors for this colitis.

Allergic colitis in infants

Food protein-induced allergic proctocolitis (FPIAP) is a frequent cause of streaks of blood in the stool of otherwise healthy, thriving babies, most often from cow's milk protein. A 2025 review describes it as benign and self-limited. The diagnosis is clinical: bleeding stops when the trigger food is removed and returns when it is reintroduced.

Other types

Cleveland Clinic also lists radiation colitis and diversion colitis (after a colostomy).

What causes colitis? Risk factors

  • Infection: C. diff after antibiotics, hospital stays, age 65 or older, a weak immune system or a previous episode (CDC); other bacteria, viruses and parasites.
  • Immune causes: ulcerative colitis and microscopic colitis. Doctors are not sure what causes them; genes, abnormal immune reactions, the gut microbiome and the environment all play a role (NIDDK). A first-degree relative with IBD raises the risk.
  • Poor blood flow: hardening of the arteries, blood clots, abnormal heart rhythm (MedlinePlus). A systematic review of 18 case reports also linked ischemic colitis to over-the-counter decongestants (pseudoephedrine, phenylephrine), mostly in women.
  • Medicines: NSAIDs, PPIs, SSRIs and others (microscopic colitis), checkpoint inhibitors (immune colitis), any antibiotic (C. diff).
  • Smoking: linked with microscopic colitis, and smokers develop it younger (NIDDK).
  • Associated diseases: celiac disease, rheumatoid arthritis, thyroid disease and type 1 diabetes are more common with microscopic colitis. Read more on celiac disease versus gluten intolerance.

Colitis symptoms

The NIDDK and Cleveland Clinic list these common symptoms:

  • diarrhea, watery or with blood, mucus or pus;
  • cramping and belly pain, bloating;
  • urgency, and tenesmus (feeling you need to go even when the bowel is empty);
  • fever, fatigue, nausea, weight loss and loss of appetite, mainly in severe disease;
  • outside the gut in IBD: joint pain, eye irritation, skin lumps or ulcers.

Bloody diarrhea suggests ulcerative, infectious or ischemic colitis. Watery, non-bloody diarrhea, sometimes at night, suggests microscopic colitis. Sudden pain followed by bleeding in an older adult suggests ischemic colitis. Diarrhea during or after antibiotics suggests C. diff. For a broader view, see our guide to diarrhea causes and when to worry and our page on rectal bleeding.

Symptoms of an ulcerative colitis flare-up

The NIDDK grades flares by stool frequency: mild disease means fewer than four bowel movements a day, sometimes with blood; severe disease means more than six a day with blood most of the time; fulminant disease means more than 10 bloody bowel movements a day. Fever, fast heart rate, weight loss and fatigue signal more severe disease.

Colitis vs Crohn's disease vs IBS

Ulcerative colitis affects only the colon and rectum, in a continuous pattern from the rectum upward. Crohn's disease can affect any part of the digestive tract, from the mouth to the anus (MedlinePlus). Our Crohn's disease guide explains its tests and treatments.

Irritable bowel syndrome (IBS) causes pain and diarrhea or constipation without inflammation, so calprotectin is usually normal and a colonoscopy, when done, is often normal. Microscopic colitis is a classic IBS look-alike: only biopsies tell them apart.

How is colitis diagnosed?

Doctors start with your history (antibiotics, travel, new medicines, immunotherapy, family history) and an exam, then order tests to confirm colitis, judge its severity and rule out look-alikes (NIDDK).

Stool tests

  • C. difficile toxin and PCR tests: the AGA (2026) prefers multistep testing for the best accuracy, and advises against a routine "test of cure" after treatment.
  • Stool culture to look for harmful bacteria, and an ova and parasites test when travel or water exposure is likely.
  • Fecal calprotectin, a protein released by neutrophils in an inflamed bowel, and fecal lactoferrin: both flag inflammation and help separate IBD from IBS.

Blood tests

  • Complete blood count: a low hemoglobin points to anemia from bleeding or poor iron absorption; a high white blood cell count suggests infection or severe inflammation.
  • C-reactive protein (CRP) and the ESR: markers of inflammation used to judge severity and follow treatment.
  • Albumin: low levels reflect severe inflammation, protein loss or poor nutrition.
  • Kidney function and electrolytes such as potassium: diarrhea can cause dehydration with electrolyte imbalance; in C. diff, a creatinine above 1.5 times baseline marks severe infection.
  • Lactate in suspected ischemia: MedlinePlus notes that acute intestinal ischemia can raise white cells and lactic acid.
  • Celiac antibodies when microscopic colitis is suspected.

Colonoscopy, sigmoidoscopy and imaging

Colonoscopy (whole colon) or flexible sigmoidoscopy (rectum and lower colon) with biopsies confirms ulcerative colitis, shows its extent and rules out other diseases (NIDDK). Biopsies are the only way to diagnose microscopic colitis, even when the lining looks normal. A CT scan helps in suspected ischemic colitis and in complications; a 2026 study of 174 patients validated a CT score to predict severe ischemic colitis.

Fecal calprotectin and other key test results

Calprotectin is reported in µg/g of stool (the same value in mg/kg, the SI-style unit). Cut-offs depend on the lab and the question asked, so always read your report's reference range.

Test and result (US unit / SI unit)SituationWhat it usually means
Fecal calprotectin below 50 µg/g (50 mg/kg)New diarrhea, IBD vs IBS questionIBD unlikely (pooled sensitivity 93%, specificity 94% at this cut-off)
Fecal calprotectin 50-150 µg/g (50-150 mg/kg)BorderlineMost people do not have IBD; a repeat test may be appropriate
Fecal calprotectin below 150 µg/g (150 mg/kg)Known ulcerative colitis, no symptomsActive inflammation ruled out; routine colonoscopy can be avoided (AGA)
Fecal calprotectin above 150 µg/g (150 mg/kg)Known ulcerative colitis, moderate to severe symptomsActive disease; supports treatment changes (AGA)
CRP below 0.3 mg/dL (3 mg/L)Most healthy adultsNo marked inflammation; 1-10 mg/dL (10-100 mg/L) is a moderate rise
ESR (Westergren) under 15-20 mm/hr (men), 20-30 mm/hr (women)Adults, limits rise after 50Higher values suggest inflammation, anemia or other causes
White blood cells above 15,000/µL (15 × 10⁹/L)C. difficile infectionSevere infection, higher risk of recurrence (AGA 2026)
Creatinine above 1.5 times baselineC. difficile infectionSevere infection (AGA 2026)

How to read your results

A normal calprotectin with normal blood tests is reassuring and often points toward IBS or a short infection. A high calprotectin says that the bowel is inflamed, not why, so stool infection tests and often a colonoscopy are still needed. In infants, calprotectin is unreliable for allergic proctocolitis. In someone with known ulcerative colitis, the AGA suggests a normal biomarker with no symptoms can replace routine colonoscopy, but a high marker without symptoms, or symptoms with a normal marker, should lead to endoscopy.

Types of colitis at a glance

TypeTypical person and symptomsKey testMain treatment
Ulcerative colitisOften 15-30 years; bloody diarrhea, urgencyColonoscopy with biopsies; calprotectin, CRP5-ASA, steroids, biologics, small molecules
Microscopic colitisAverage 60-65 years, mostly women; watery non-bloody diarrheaBiopsies of a normal-looking colonStop trigger drugs; budesonide
Ischemic colitisOlder adults with vascular disease; sudden pain then bleedingCT scan, colonoscopy; WBC, lactateFluids, bowel rest; surgery if severe
C. difficile colitisAfter antibiotics, hospital stay, 65+; watery diarrhea, feverStool toxin and PCR testsFidaxomicin or vancomycin; microbiota therapy for recurrences
Other infectious colitisFood, water or travel exposureStool culture, pathogen panel, ova and parasitesFluids; antibiotics or antiparasitics when needed
Checkpoint inhibitor colitisPeople on cancer immunotherapyEndoscopy with biopsyCorticosteroids; infliximab or vedolizumab
Allergic proctocolitisHealthy infants; blood-streaked stoolsClinical: improvement after removing the triggerMaternal dairy elimination or hydrolyzed formula

How is colitis treated?

Ulcerative colitis treatment

The goals are to control flares, keep remission and heal the lining (MedlinePlus). Options include 5-aminosalicylates (mesalamine, sulfasalazine) for mild to moderate disease, short courses of corticosteroids, immunosuppressants, biologics and small-molecule drugs. In its 2024 living guideline, the American Gastroenterological Association (AGA) recommends infliximab, golimumab, vedolizumab, tofacitinib, upadacitinib, ustekinumab, ozanimod, etrasimod, risankizumab and guselkumab for moderate to severe ulcerative colitis, and suggests early use of advanced therapies rather than waiting for 5-ASA to fail. Removing the colon cures the disease and is used when medicines fail, for dysplasia or cancer, or for complications such as toxic megacolon. For pain, acetaminophen is preferred: NSAIDs can make symptoms worse (NIDDK).

In a 2026 US study of 3,893 adults newly diagnosed with ulcerative colitis, the 5-year risk of IBD-related hospitalization was 11% and of colectomy 6%. See also why flares come back during IBD remission.

Microscopic colitis treatment

Stop smoking and review medicines that may trigger it. First-line therapy is budesonide, 9 mg a day for 6 to 8 weeks, which induces remission effectively; relapses are common, and long-term options include low-dose budesonide, bile acid binders, antidiarrheals and, for refractory cases, advanced therapies (Annual Review of Medicine, 2026).

C. difficile treatment

The 2026 AGA expert review favors fidaxomicin 200 mg twice daily for 10 days, with oral vancomycin 125 mg four times daily for 10 days as an acceptable alternative; metronidazole should not be used outside fulminant disease. Microbiota-based therapies are offered after a second recurrence. MedlinePlus notes that up to 1 in 5 infections come back.

Ischemic colitis treatment

Most episodes are transient and treated with fluids, bowel rest and treatment of the cause. In a 2024 meta-analysis of 12,420 patients, 15% needed surgery; right-sided ischemic colitis (also 15% of cases) carried higher mortality and more surgery. A comprehensive review notes the diagnosis is made at presentation in only 9% of patients, so prompt imaging matters.

Checkpoint inhibitor colitis and allergic colitis

Immune checkpoint inhibitor colitis is treated with corticosteroids, then infliximab or vedolizumab when needed (2023 review). Infant allergic proctocolitis is managed with the least restrictive diet: maternal dairy elimination for breastfed babies or an extensively hydrolyzed formula, with earlier reintroduction once the colitis resolves (2025 review).

Colitis diet: what to eat

No specific food causes ulcerative colitis, and researchers have not found foods that worsen it for everyone (NIDDK). During a flare, MedlinePlus suggests:

  • small meals through the day and water in small, frequent sips;
  • fewer high-fiber foods (bran, beans, nuts, seeds, popcorn) and fatty, greasy or fried foods;
  • limiting milk products if you are lactose intolerant;
  • a food diary to spot your own triggers, with a dietitian if you are losing weight.

After C. diff, the AGA advises a varied diet rich in fruits and vegetables with soluble and insoluble fiber; psyllium can bulk stools once you have recovered. The NIDDK notes that doctors may recommend calcium and vitamin D to slow bone loss in ulcerative colitis.

Prevention and long-term follow-up

  • Avoid unnecessary antibiotics, especially after a past C. diff infection, and wash hands well: alcohol sanitizers do not always work against C. diff (MedlinePlus).
  • Control blood pressure, cholesterol and diabetes, and stop smoking, to protect gut blood vessels.
  • Take ulcerative colitis maintenance therapy even when you feel well; check in with your team before any change.
  • Ulcerative colitis raises colon cancer risk over time, especially when a third or more of the colon is involved (NIDDK), so surveillance colonoscopies are planned. Learn more about colorectal cancer symptoms and screening.

Colitis in children, older adults and pregnancy

In babies, blood-streaked stools with normal growth often point to allergic proctocolitis, which resolves with time. Ulcerative colitis can slow growth and puberty in children. Microscopic colitis also occurs in children: a 2026 Mayo Clinic series found 42 cases (median age 12.5 years), with budesonide most effective but frequent relapse. In older adults, think of microscopic and ischemic colitis, review medicines, and watch for dehydration. During pregnancy, keep IBD treatment going under specialist care: a 2025 case report of a severe flare after a patient stopped treatment stresses that good adherence keeps complication rates close to those of women who are not pregnant.

When to see a doctor

See a doctor if diarrhea lasts more than a few days, if you have blood in your stool, belly pain that does not improve, diarrhea during or after antibiotics, or watery diarrhea for several weeks. MedlinePlus advises calling for any bloody stools after antibiotics or five or more episodes of diarrhea a day for more than 1 to 2 days.

Call 911 or go to the emergency room for severe belly pain, a swollen hard belly, heavy rectal bleeding, fainting, high fever with confusion, or signs of severe dehydration (no urine, dizziness when standing). People on cancer immunotherapy should report any new diarrhea to their oncology team promptly.

Latest scientific advances in colitis

New ulcerative colitis guidelines (ACG 2025, AGA 2024)

The American College of Gastroenterology updated its adult ulcerative colitis guideline in June 2025, using the GRADE method. It follows the AGA 2024 living guideline, which ranks drugs by efficacy and advises early advanced therapy for moderate to severe disease instead of a slow step-up. For you, this means faster access to effective treatment.

IL-23 blockers and S1P receptor modulators

Three antibodies that block the p19 subunit of interleukin-23 are now recommended by the AGA for ulcerative colitis. In the LUCENT trials (NCT03518086, NCT03524092), clinical remission at one year reached 49.9% with mirikizumab versus 25.1% with placebo. In QUASAR (NCT04033445), guselkumab achieved 50% remission at week 44 with the every-4-week dose versus 19% with placebo. In INSPIRE and COMMAND (NCT03398148, NCT03398135), risankizumab worked whether or not patients had failed other advanced drugs. Etrasimod, an oral sphingosine 1-phosphate (S1P) receptor modulator, is listed by ChEMBL as approved for ulcerative colitis since 2023. A 2026 network meta-analysis found anti-p19 drugs had the most favorable safety profile, although confidence in these safety estimates was lower.

Obefazimod, a first-in-class pill

Obefazimod is an oral drug that increases a single microRNA, miR-124. In the 96-week open-label phase 2b extension, 52.5% of 217 patients were in clinical remission at week 96. Two phase 3 induction trials (ABTECT, NCT05507203 and NCT05507216, about 1,275 patients) were completed in 2025, and the maintenance trial NCT05535946 is ongoing. In the 2026 network meta-analysis, obefazimod ranked among the most effective options in patients new to advanced therapy.

C. difficile: 2026 AGA guidance and microbiota therapies

The 2026 AGA expert review makes fidaxomicin the favored first choice, offers FDA-approved fecal microbiota products (fecal microbiota, live-jslm; fecal microbiota spores, live-brpk) or conventional transplant after a second recurrence, and advises against probiotics to prevent C. diff. A companion 2026 review for people with IBD recommends ruling out C. diff in anyone with IBD and new or worsening diarrhea, and continuing IBD treatment during the infection.

Microscopic colitis: broader criteria

A 2026 meta-analysis of 1,370 patients with "incomplete" microscopic colitis (biopsies that do not fully meet the criteria) found 46% took medicines linked to the disease and 85% reached remission with budesonide. The authors suggest broadening the diagnostic criteria.

Which tests can help?

Ask your doctor about:

  • stool: C. difficile toxin/PCR, stool culture or pathogen panel, ova and parasites, fecal calprotectin or lactoferrin;
  • complete blood count (hemoglobin, white cells, platelets) and iron studies with ferritin;
  • CRP and ESR to measure inflammation;
  • albumin, kidney function, sodium and potassium;
  • celiac antibodies (tTG-IgA) when microscopic colitis or chronic diarrhea is suspected;
  • colonoscopy with biopsies when symptoms last or markers are high.

Glossary

  • Colitis: inflammation of the colon (large intestine).
  • Proctitis: inflammation limited to the rectum.
  • Fecal calprotectin: a stool protein from white blood cells that rises when the bowel is inflamed.
  • Inflammatory bowel disease (IBD): chronic immune inflammation of the gut, mainly ulcerative colitis and Crohn's disease.
  • Biologic: an antibody medicine that blocks a specific immune signal (for example TNF, integrins or IL-23).
  • Toxic megacolon: a dangerous widening of the inflamed colon that needs emergency care.
  • Fecal microbiota therapy: transfer of healthy gut bacteria to prevent repeated C. diff infections.

Frequently asked questions

What causes colitis?

Infections such as C. diff, immune diseases, reduced blood flow, medicines (NSAIDs, cancer immunotherapy), radiation, and food protein allergy in infants.

How is colitis diagnosed?

With stool tests (infection, calprotectin), blood tests (blood count, CRP, albumin, kidney function) and, when symptoms last, a colonoscopy with biopsies; CT helps in suspected ischemic colitis.

How is colitis treated?

It follows the cause: antibiotics for C. diff, budesonide for microscopic colitis, supportive care for most ischemic colitis, and anti-inflammatory medicines for ulcerative colitis.

What are the different types of colitis?

Ulcerative, microscopic, ischemic and infectious colitis (including C. difficile), drug-induced and checkpoint inhibitor colitis, infant allergic proctocolitis, radiation and diversion colitis.

What is proctitis?

Proctitis is inflammation of the rectum only. In ulcerative colitis it is the most limited form: in a Norwegian cohort of 736 patients, 43% had proctitis at diagnosis, and it had the highest yearly risk of spreading (7.5%), so follow-up matters.

What are the symptoms of an ulcerative colitis flare-up?

More frequent and urgent bowel movements, blood or mucus in the stool, cramps and tenesmus. More than six bloody stools a day, fever or a fast pulse signal a severe flare that needs urgent care.

What are the treatment guidelines for ulcerative colitis?

The ACG 2025 and AGA 2024 guidelines tailor treatment to severity and extent: 5-ASA for mild to moderate disease, and early biologics or small molecules for moderate to severe disease, with biomarkers such as calprotectin and CRP to monitor the response.

What medication is used for colitis?

For IBD: mesalamine, steroids, azathioprine, biologics (infliximab, vedolizumab, mirikizumab, guselkumab, risankizumab) and pills (tofacitinib, upadacitinib, ozanimod, etrasimod). For C. diff: fidaxomicin or vancomycin. Avoid NSAIDs for pain.

Sources

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  • Singh S et al. — AGA Guideline on Biomarkers in Ulcerative Colitis — Gastroenterology, 2023 — doi.org
  • Waugh N et al. — Faecal calprotectin testing: systematic review — Health Technol Assess, 2013 — doi.org
  • Lewis JD et al. — Incidence and Prevalence of IBD in the United States — Gastroenterology, 2023 — doi.org
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  • Rubin DT et al. — Guselkumab in ulcerative colitis (QUASAR) — Lancet, 2025 — doi.org
  • Panaccione R et al. — Risankizumab by prior advanced therapy (INSPIRE, COMMAND) — J Crohns Colitis, 2025 — doi.org
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  • Olivera PA et al. — Advanced Therapies for Ulcerative Colitis: Network Meta-Analysis — Clin Gastroenterol Hepatol, 2026 — doi.org
  • Abivax — Obefazimod induction trial (ABTECT-1, NCT05507203) — ClinicalTrials.gov — clinicaltrials.gov
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  • Abivax — Obefazimod maintenance trial (NCT05535946) — ClinicalTrials.gov — clinicaltrials.gov
  • Fischer M et al. — AGA Update on C. difficile Infection in Adults — Clin Gastroenterol Hepatol, 2026 — doi.org
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  • Qian W et al. — Surgery in ischemic colitis: meta-analysis — World J Surg, 2024 — doi.org
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Further reading

Understand your lab results with AI DiagMe

A colitis work-up brings many results at once: calprotectin, CRP, ESR, blood count, albumin, potassium, kidney function and stool test reports. AI DiagMe reads your lab report in minutes, explains each value in plain language, flags what may point to inflammation, infection or anemia, and suggests questions to ask your doctor. Upload your lab results to AI DiagMe for a clear, personal report.

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