What is a key differentiating symptom between ulcerative colitis and Crohns disease?

Best practices for distinguishing between Crohn’s disease and ulcerative colitis when assessing patients who present with symptoms of inflammatory bowel disease and counseling patients and loved ones on treatment selection and goals. 

Stephen Hanauer, MD: One of the issues that you mentioned is differentiating ulcerative colitis and Crohn disease. Ulcerative colitis being a diffused continuous superficial process starting in the anal verge and extending proximally, and Crohn disease being able to impact virtually anywhere in the digestive tract. You mentioned that in young kids, many patients develop a colitis to begin with, and we become more confident or satisfied with the diagnosis of indeterminate colitis. The problem is patients and their parents want a diagnosis. How do you handle that?

Marla Dubinsky, MD: I talk to them the way that we talked about, whereby there’s a spectrum of biology. I talk to them about the fact that even with an adult who goes to colectomy, I’m sure Steve you could agree, you can’t say with 100% certainty that they’re not going to develop Crohn-like inflammation of the pouch. We can’t, there’s too much overlap, right?

Stephen Hanauer, MD: There’s a pathologist from the Cleveland Clinic previously who said, there’s nothing like an ileoanal anastomosis to bring out the Crohn disease in someone.

Marla Dubinsky, MD: I resonate with that statement. Obviously, we may be biased because we see a higher level or more complex patients, but I do feel that I can’t at this point tell them with certainty. What I try to explain is that we focus less on the categories, but we focus on therapies that work predominantly in a more colitis-type phenomena and walk them through that this is something you cannot predict. We’re hopefully in the future going to get better biomarkers or a better way of knowing that before we send them to colectomy. But it’s not 100%, it just isn’t, and that’s what I’m honest about. I don’t want to be telling them that you’re done, drop the mic, no more therapies and no more issues, and just remove the colon. That would be a false sense of security in my opinion.

Transcript Edited for Clarity

What is the difference between Crohn’s disease and ulcerative colitis?

Both Crohn’s disease and ulcerative colitis are inflammatory bowel diseases (IBD), however, there are distinct differences between these diseases. This video developed by the GI Society with Dr. Mike Evans, illustrates the differences between Crohn’s disease and ulcerative colitis, the impact of these diseases, possible causes and prevalence.

Inflammatory Bowel Disease video courtesy of GI Society

Site of inflammation differs between Crohn’s disease and ulcerative colitis

Crohn’s disease can affect any part of the gastrointestinal tract, including the mouth, esophagus, stomach, small and large intestines, rectum and anus.  Ulcerative colitis is located in the colon, usually starting from the rectum.  In Crohn’s disease, inflammation occurs in all layers of the intestinal wall and patches of this inflammation can be scattered throughout the GI tract.  In contrast, in ulcerative colitis, inflammation occurs in the innermost lining of the intestinal wall and is a continuous stretch within the colon.

Symptoms common to both Crohn’s disease and ulcerative colitis

Symptoms of Crohn’s disease and ulcerative colitis present quite similarly and include the following:

• Abdominal pain
• Diarrhea
• Nausea
• Vomiting
• Loss of appetite
• Weight loss
• Fever
• Fatigue

Symptomatic differences between Crohn’s disease and ulcerative colitis

There are some subtle differences in symptoms of Crohn’s disease and ulcerative colitis.  In Crohn’s disease rectal bleeding is less common, whereas in ulcerative colitis, bleeding from the rectum is much more common.  In Crohn’s disease, continuous abdominal pain is more common and perianal problems such as fistulas, anal sores and skin tags, can occur.  In contrast, people living with ulcerative colitis usually have intermittent pain coinciding with bowel movements. Perianal issues are uncommon in ulcerative colitis.

What is a key differentiating symptom between ulcerative colitis and Crohn's disease?

What are the symptoms of ulcerative colitis and Crohn's disease?

What diagnostic test is preferred to differentiate between ulcerative colitis and Crohn's disease?

Which characteristic is present in Crohn's disease but not in ulcerative colitis?