Differentiating Crohn’s Disease & Ulcerative Colitis
There are a lot of similarities between Crohn's disease and ulcerative colitis. Together, these two conditions are group in as Inflammatory Bowel Disease.
To a degree, they look quite similar [1]:
Crohn's Disease
Ulcerative Colitis
Age
Any
Any
Gender
Male = Female
Male = Female
Population Distribution
75 / 100 000
150 /100 000
Ethnic Group
Any; more common in Ashkenazi Jews
Any
Genetic Factors
CARD 15/NOD-2mutations predispose
HLA-DR103 associated with severe disease
Risk Factors
More common in smokers
More common in non-/ex-smokers; appendectomy protects
Diagnosis
Biopsy
Biopsy
But when you see a trained professional, your history, physical examination and lab testing will help differentiate the two [1].
Crohn's Disease
Ulcerative Colitis
Symptoms
Constant pain (right lower quadrant)
Diarrhea (watery, no blood or mucus)
Not relieved with Bowel Movement
Mass often at right lower quadrant
Variable pain, Lower Abdominal Cramps
Bloody Diarrhea
Relieved with Bowel Movement
No abdominal mass
Proctitis: rectal bleeding, mucus discharge, tenesmus
Proctosigmoiditis: bloody diarrhea, with mucus, some develop fever, lethargy and abdominal discomfort
Extensive pancolitis: blood diarrhea, passage of mucus, severe cases will present with weight loss, malaise, abdominal pain, toxic syndrome, fever, tachycardia, signs of peritoneal inflammation
Location / Anatomical Distribution
Can involve any area of GI tract
Sites of involvement (most common to least)
-
- Terminal ilium and right side of colon
-
- Colon alone
-
- Ileum alone
-
- Ilium and jejunum
Mouth to anus potentially affected
Discontinuous: "Skip" lesions
Typically limited to colon
-
- Proctitis (rectum)
-
- Protosigmoiditis (rectum and sigmoid colon)
-
- Pancolitis: whole colon
Onset at the rectum
Continuous from rectum
Histopathology (Changes to the tissue) Findings on Colonoscopy
Crohn's Disease involves the entire bowel wall, with skip lesions
Cobblestoning
Deep fissuring ulcers, fistulas, strictures
Patchy changes
Transmural disease (Granulomas)
Ulcerative colitis is limited to the mucosa and submucosa
Crpyt distortion, crypt abscesses
Pseudopolyps
Loss of goblet cells
No Granulomas
About the Author - Dr. Johann de Chickera
Dr. Johann is a fully licensed Naturopathic Doctor. His approach emphasizes the importance of living a healthy lifestyle and improving one’s health naturally. Dr. Johann obtained a Doctor of Naturopathy at the Canadian College of Naturopathic Medicine (CCNM). Education at CCNM is a vigorous four years, with a curriculum involving biomedical sciences, physical diagnosis, clinical nutrition, traditional Chinese medicine and acupuncture, botanical (herbal) medicine, physical medicine, homeopathy and lifestyle management.
While Dr. Johann has a general practice, he focuses on fertility, hormonal imbalances, gut health, and autoimmune disease.
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