Teach Me

Crohn’s Disease and Colitis: Why It’s Crucial to Get the Right Diagnosis

Maybe you’re dealing with some unpleasant gastrointestinal issues. You have diarrhea, abdominal cramping and perhaps blood in your stool. Plus, you might feel tired, you don’t have much of an appetite and you’re losing weight without trying.

These symptoms could be signs of two different types of inflammatory bowel disease, Crohn’s disease (CD) and ulcerative colitis (UC). They are both chronic diseases that strike your digestive system, and they have a lot of things in common. They both:

  • Can occur at any age but often develop in teenagers and young adults.
  • Affect men and women equally.
  • Have similar symptoms.
  • Can be caused by a range of factors, including genetics, environmental triggers, an imbalance of intestinal bacteria and inappropriate immune system responses.

“We don’t have a good understanding of why people develop either CD or UC,” said Avin Aggarwal, MD, a gastroenterologist with Banner - University Medicine. “And the course of Crohn’s disease and ulcerative colitis is sometimes unpredictable. Selecting appropriate treatment strategies requires a personalized approach for each patient.”

Some patients recover after a single attack or are in remission for years, while others often need hospitalization and surgery. Some people have many symptoms, while others have just a few. And some people have intense symptoms that often strike, while others only have mild, occasional issues. 

Here’s how these conditions differ from each other

Crohn’s disease and ulcerative colitis are both types of inflammatory bowel diseases. They have some different characteristics, but they overlap substantially.

Crohn’s disease can affect any part of the gastrointestinal tract from the mouth to the anus. You’ll have inflammation that involves all the layers of the bowel wall. You could have segments of diseased bowel interspersed with areas of normal bowel. You might have scar tissue that builds up and causes the narrowing of the intestines.

With ulcerative colitis, you’ll only have inflammation on the inside layer of the large intestine. It usually encompasses the large intestine continuously. Scar tissue is possible, but unlikely to cause narrowing or blockage of the intestines like with Crohn’s disease.

How to diagnose CD and UC

If your doctor suspects Crohn’s disease or ulcerative colitis, they will probably recommend that you have a colonoscopy, which examines your large intestine. A colonoscopy will usually show whether you have CD or UC and how severe your disease is. 

“About 10% to 15% of people with inflammation of the colon have indeterminate colitis. That means it is difficult to determine whether they have CD or UC,” Dr. Aggarwal said. Other tests, including X-rays, CT scans, blood tests and sigmoidoscopies, can help diagnose these diseases and determine how severe they are.

“Correct diagnosis is important for staging how severe the disease is, identifying complications associated with each disease, planning treatment and predicting long-term outcomes,” Dr. Aggarwal said.

Treatment options for CD and UC

It’s essential to treat both conditions. Without proper treatment, symptoms may get much worse, and your risk of complications such as abscesses, obstruction, malnutrition and anemia increases. And colon cancer can be a serious complication of long-term ulcerative colitis or Crohn's disease, even in someone who is in remission.

“With diagnosis and treatment, many people see improvement in their quality of life because they are finally able to address the problems they were experiencing,” Dr. Aggarwal said.

For both Crohn’s disease and ulcerative colitis, treatment can help:

  • Control inflammation
  • Alleviate symptoms
  • Prevent recurrence
  • Maximize quality of life

“It’s important to use a personalized approach to treat both of these types of inflammatory bowel disease because every person and every case is different,” Dr. Aggarwal said. 

Treatment options for both conditions include:

  • Medications such as aminosalicylates (5-ASA), corticosteroids, immunomodulators and antibiotics
  • Biological therapies, which are medications that help control diseases by blocking specific pathways of inflammation in the gut
  • Nutritional strategies to try during flares, such as eating smaller, more frequent meals that include fatty fish, and limiting caffeine, prunes and fresh fruits and vegetables 
  • Complementary therapies such as mindfulness, hypnosis, acupuncture, yoga and exercise to help manage symptoms

People who don’t get control of their symptoms with medication and other therapies or who have certain complications may need surgery to remove the diseased part of their digestive system.

“New treatments are constantly being developed based on research of the immune system's role in IBD symptoms,” Dr. Aggarwal said.

With proper treatment and lifestyle changes, most people with CD and UC can live their lives just as they did before they were diagnosed. While the course is more challenging for some people than others, depending on their disease and how they respond to treatment, most people can expect to live long, fulfilling lives. 

The bottom line

Crohn’s disease and ulcerative colitis, two different types of inflammatory bowel diseases, have similar symptoms, including diarrhea, abdominal cramping, bloody stool, fatigue, loss of appetite and unexplained weight loss. If you have these symptoms, talk to your doctor. The right diagnosis can help you find the right treatment so you can control your disease.

Need help diagnosing or treating inflammatory bowel disease?

Schedule an appointment with a gastroenterologist.

Other useful articles