Due to their similar symptoms, ulcerative colitis (UC) and Crohn’s disease can often be confused. This can lead to misdiagnosis and, ultimately, improper treatment.
One of the most important differences between the two conditions relates to where in your digestive tract inflammation occurs. Understanding this difference can help your GI specialist decide which treatment method to use.
Symptoms
In Crohn’s disease, healthy cells in the digestive tract mistakenly attack themselves. This causes inflammation and damage to the bowels. Some symptoms include diarrhea, blood in your stool, fatigue, weight loss and abdominal pain. The rash can also cause problems such as fistulas (abnormal tunnel-like openings), scar tissue and blockage of the intestines.
Treatment can include diet changes, medicines and surgery. Some people with mild symptoms respond to antidiarrheal therapies such as loperamide (Imodium). Other drugs, such as aminosalicylates or aspirin-like medications called 5-ASAs, may help control your symptoms. Immunosuppressive medicines, such as methotrexate (Methotrexate) or azathioprine (Imuran), can reduce inflammation levels. These drugs can also lower your risk of infection and relapses.
Surgery to remove part or all of your bowel can treat severe cases of Crohn’s disease, such as a complete intestinal obstruction. A surgeon can make an opening in your abdomen, and connect a pouch to this opening, called a stoma, which collects your feces outside your body. People who have this type of surgery can often live a normal life.
Ulcerative colitis causes irritation and ulcers in your colon or large intestine. It is one of the conditions in a group called inflammatory bowel disease, or IBD. Inflammation from UC can also cause abdominal pain, diarrhea, and weight loss. It can lead to malabsorption or inability to absorb nutrients from your food.
Diagnosis
Doctors can diagnose Crohn’s disease and ulcerative colitis by using a variety of tests. A physical exam, a medical history and blood tests to check for low levels of red blood cells are all part of the diagnosis. Stool testing is also used to determine inflammation in your colon. The doctor can see the inside of your large intestine, which is often affected by Crohn’s. It can reveal swollen or ulcerated areas in the lining. Granulomas can also be present.
The doctor can examine the esophagus (the tube that connects the mouth to the stomach) and the small intestine. These tests can reveal ulcers and inflammation in the digestive system.
Inflammation caused by Crohn’s can cause the formation of scar tissue in the intestinal walls, which may partially or fully block the bowels. Fistulas can be abnormal openings in the intestine’s walls. They can be infected and may require surgery. Other health problems, such as abdominal pain, malnutrition and loss of appetite, can result. This condition can also cause problems with vitamin D absorption, resulting in poor bone health. It is not known what causes Crohn’s, but the disease can run in families.
Treatment
Many people with Crohn’s disease experience remissions that reduce or eliminate their symptoms. But the disease can recur at any time, leading to flare-ups. Treatment focuses on managing symptoms and preventing outbreaks.
Medications can help control the inflammation of your digestive tract and colon. Your doctor may prescribe a combination of medicines to treat your Crohn’s flare. For example, aminosalicylates affect parts of your inflammatory response, decreasing tissue irritation. They’re most often used to treat ulcerative colitis but can be used to treat mild Crohn’s disease in the colon.
Your doctor may also recommend a diet to help manage your symptoms. A low-residue diet limits the amount of food that enters your bowels and may decrease diarrhea. Your doctor may suggest taking a stool sample for tests to check for inflammation and bacteria that cause infection. They may also recommend a colonoscopy or upper gastrointestinal series, where they place barium in your stomach and small intestine to examine the lining of your bowel for thickening.
In severe cases, you may need surgery. This may include removing the inflamed section of your colon or rectum. You may need surgery to widen a narrowed area of your bowel, called a stricture. You might need surgery to drain abscesses or to close fistulas. Some people require a surgical procedure to remove the large intestine, called a colectomy. During this procedure, doctors create an opening in your abdominal wall and connect it to a pouch that collects your feces, called a stoma.
Prevention
While there is no cure for Crohn’s disease, symptoms and complications can be prevented by taking medication that reduces inflammation and suppresses the immune system. The treatment you take depends on the type of Crohn’s you have. You may need a medicine that stops flare-ups (corticosteroids). Or you may need medications to lower your immune response, such as immunosuppressants or biological medicines like adalimumab, infliximab and vedolizumab.
Other medications to treat Crohn’s disease include antibiotics, such as ciprofloxacin (Cipro) or metronidazole (Flagyl), to help ward off infections in your digestive tract that can cause abscesses or fistulas, and drugs for diarrhea, such as loperamide (Imodium). A doctor might also recommend a low-residue diet, which helps prevent intestinal blockage if you have a narrowed bowel.
Your doctor might also recommend a capsule endoscopy, in which you swallow a pill with a camera inside to look at your small intestine. Or you might need a CT enterography to get pictures of your digestive tract, but this test has risks such as radiation exposure and can be uncomfortable.
If you’re very sick with Crohn’s, your doctor might have to put you on bowel rest, in which you don’t eat for several days or weeks so that your bowel can heal. You might have to drink liquids or get nutrients infused through a tube in your nose (enteral nutrition) or into your veins (total parenteral nutrition, or TPN). Sometimes, your doctor must drain an abscess with a needle or surgery.