What is the Difference in Crohn’s Disease and Ulcerative Colitis?

Medically reviewed by: Gary H. Hoffman, MD

Crohn’s disease and ulcerative colitis are the two most common types of Inflammatory Bowel Disease (IBD), a condition that affects more than 1.6 million people in the United States. IBD occurs when the body’s immune system reacts abnormally, and attacks parts of the gastrointestinal tract. The cause is unknown, but treatment can often help patients achieve and maintain remission.

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While Crohn’s disease and ulcerative colitis have shared symptoms, they affect people in different ways. They also affect different sections of the gastrointestinal tract.

What are the Shared Symptoms of Crohn’s and Ulcerative Colitis?

Because Crohn’s and ulcerative colitis are both conditions caused by an inflammatory reaction in the gastrointestinal tract, they share some of the same symptoms. Many patients with all types of IBD report general symptoms that could indicate almost any illness, including:

  • Fever
  • Fatigue
  • Loss of appetite and weight loss

Symptoms specific to the gastrointestinal tract may include:

  • Constipation or diarrhea
  • Rectal bleeding
  • Urgent or frequent need to use the bathroom
  • Abdominal cramping
  • A feeling of being unable to completely empty your bowels

What is Crohn’s Disease?

Crohn’s disease can cause inflammation in any part of the gastrointestinal tract. In some people it affects the upper GI tract, although it its most common location is the ileum — the end of the small bowel — and the top end of the colon. Only rarely does Crohn’s affect the entire area. Instead, it affects only some areas leaving patches of normal lining between affected areas. Crohn’s disease is capable of damaging the complete thickness of the bowel wall in the most severe cases.

What is Ulcerative Colitis?

Ulcerative colitis causes inflammation in the large intestines, also known as the colon. This inflammation can cause ulcers, and leads to abdominal cramping. Patients with ulcerative colitis often report that they have frequent, urgent loose bowel movements. Unlike Crohn’s disease, ulcerative colitis only affects the lining of the colon, and cannot damage the entire bowel wall. Ulcerative colitis also affects the entire area, leaving no healthy patches, also known as skip areas.

How are these Conditions Diagnosed?

In most cases, you will need to see a colon and rectal specialist to confirm a diagnosis of either Crohn’s disease or ulcerative colitis. Many general practitioners are unfamiliar with these conditions, and they are typically hard to differentiate without further testing due to their similar symptoms. To further complicate matters, about ten percent of patients have a condition known as indeterminate colitis, in which the diagnostic features of both Crohn’s disease and ulcerative colitis are present.

Several tests are typically used to diagnose Crohn’s, colitis or other forms of IBS. Blood tests and laboratory tests on a stool sample are often first, with endoscopic tests to follow. Depending on the symptoms, your doctor will either perform an upper endoscopy or a colonoscopy.

An upper endoscopy requires inserting a flexible tube equipped with a camera through the mouth and into the gastrointestinal tract. This test gives the doctor a look at the upper GI area, as far down as the duodenum, the top portion of the small intestine.  The procedure, also known as esophagogastroduodenoscopy (or EGD for short), is performed under anesthesia.

A colonoscopy allows doctors to visually inspect the lower portion of the GI area. This is done by inserting a thin flexible tube-shaped camera through the anus and into the colon. The images picked up by the camera are then projected onto a screen, allowing the doctor to look for signs of Crohn’s or ulcerative colitis, or other causes for your symptoms. This procedure is also performed under anesthesia.

In some cases, an EGD will be enough to confirm a diagnosis. In other cases, the doctor will need to take a small sample, or biopsy of the affected tissues. . This is done in conjunction with the colonoscopy, and is painless. The tissue sample is analyzed in the lab to determine potential causes of your symptoms.

Other tests may also be employed to determine whether a patient suffers from Crohn’s, colitis or another condition. Most frequently this includes contrast barium X-rays of the upper and lower gastrointestinal tract.

Are Effective Treatments Available?

IBD symptoms are often cyclical, with flare-ups being followed by periods of remission when symptoms lessen or disappear. Naturally, these remission periods typically last a few months, but with proper treatment they may be extended. This is, in fact, the goal of many treatments for Crohn’s and ulcerative colitis.

There is not one standard treatment that works for all people diagnosed with Crohn’s colitis or other IBDs. Even when two patients have the same diagnosis, their bodies are affected differently and the same treatment may not work for both of them. For this reason, treating IBD is somewhat difficult until you and your doctor can find the right combination of treatment options.

For most people, a combination of medication and diet changes is effective at bringing on remission and helping them remain there. In some cases, not uncommonly in Crohn’s disease,, surgery is necessary to repair damaged areas in the gastrointestinal tract.

What Should I do if I have Symptoms of Crohn’s Disease or Ulcerative Colitis?

If you have any symptoms of IBD, it is important to see your doctor as soon as possible. Crohn’s disease and ulcerative colitis can only be diagnosed by a medical professional. Crohn’s and colitis can seriously interfere with your everyday life, as well as lead to drastic weight loss and other health concerns. The symptoms may also indicate other, more serious health concerns such as colon cancer.  Early diagnosis and treatment are essential in cases of IBD.

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