Crohn's Disease vs. Ulcerative Colitis: What's the Difference?

By Amar Naik, MD, Digestive Health Program

There are close to three million patients with inflammatory bowel disease (IBD) in the United States. Even with so many people affected, there is still confusion about what exactly IBD is, its subtypes and how to manage the disease.

Crohn’s disease and Ulcerative colitis (UC) are the most common subtypes of inflammatory bowel disease, a group of chronic inflammatory disorders of the digestive tract.

Both Crohn’s and UC cause intestinal damage due to an exaggerated immune response. This response results in the damage of healthy cells and can persist for months or years.

While Crohn's disease and ulcerative colitis are very similar, there are some key differences between the two.

Key Differences

Area affected

• Crohn’s disease: The entire gastrointestinal tract
• Ulcerative colitis: The colon only

Inflammation

• Crohn’s disease: Through all the layers of the intestinal wall
• Ulcerative colitis: Only on the superficial layer of the colon wall

The type of inflammation in Crohn’s can result in strictures (narrowing) of the intestines and abnormal connections through the weakened walls of the intestine and even the anus due to ongoing damage.

Symptoms of IBD

Common symptoms of inflammatory bowel diseases are:

• Diarrhea
• Rectal bleeding
• Abdominal pain
• Weight loss
• Anemia

Patients with IBD may experience issues with other organ systems as well, including joint inflammation, eye inflammation or even skin disorders. These conditions are often related to IBD itself, and can occur during an IBD flare-up.

Patients with IBD may be at higher risk of developing other autoimmune conditions including thyroiditis, rheumatoid arthritis or psoriasis.

Risk factors for IBD include smoking, a family history of IBD and living in urban or northern climates.

IBD patients (even when young) are at higher risk for colon cancer after having had disease that affects their colon for a longer period.

For these IBD patients, in addition to effective medical treatment, a high-definition colonoscopy with targeted biopsies performed by the experienced gastroenterologists at Loyola can reduce this higher colon cancer risk.

Diagnosis of IBD

The first test for inflammatory bowel disease is a colonoscopy (with intestinal biopsies) to look for signs of chronic inflammation. Other tests include CT scan or MRI scans, a video capsule endoscopy, blood tests and stool tests.

There is no cure for IBD, but well-timed treatments can begin and maintain remission of the disease, thus decreasing long-term disease complications.

Treatment

Effective treatment depends on the patient’s severity of IBD.

• First step: Anti-inflammatory medications can be an effective initial step to treat mild colon inflammation.
• Short-term: Steroids can be used as a short-term bridge to effective long-term therapy as the disease progresses.
• Long-term: Immune-suppressing medications are effective in the long-term treatment of moderate to severe IBD.

Sometimes an operation may also be needed for treatment. If an operation becomes necessary, the inflammatory bowel disease team at Loyola Medicine will work together and discuss surgical options, including less-invasive laparoscopic approaches to remove parts of the affected colon or small intestine.

At Loyola, an ongoing personalized care plan (including the latest immunosuppressive treatments for those that need it) is developed for each patient to address multiple aspects of disease management.

Multidisciplinary care management allows us to deliver efficient medical and surgical care. We use proven health maintenance strategies and preventive care, as well as ongoing assessments to relate health to quality of life.

We also offer a unique Behavioral Medicine program to address the impact of stress/anxiety and how to cope with this chronic illness. Loyola’s IBD team offers a 24/7 inpatient IBD consultative service at Loyola University Medical Center, ensuring the IBD team is available when patients need us the most.

Please contact your physician for a referral if you have any concerns or symptoms of IBD.

Amar Naik, MD, is a gastroenterologist and director of the inflammatory bowel disease program at Loyola Medicine. His clinical interests include inflammatory bowel disease.

Dr. Naik earned his medical degree at the University of Illinois College of Medicine, Chicago. He completed a residency in internal medicine at the Medical College of Wisconsin and a fellowship in gastroenterology and hepatology at the Medical College of Wisconsin.

Book an appointment today to see Dr. Naik or another Loyola specialist by self-scheduling an in-person or virtual appointment using myLoyola.