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

AUTOIMMINE_IBD_Difference between crohns and colitis LOCATIONS

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

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Dr. Johann de Chickera works in the cities of Hamilton and Toronto, in Ontario Canada.

His clinical focus lies in Autoimmune Disease. Click here to learn more about Autoimmune Pages.

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