The Difference Between Colitis and Crohn’s Disease
It’s easy to confuse Crohn’s disease and ulcerative colitis. Both are chronic, inflammatory bowel diseases. Both cause painful, unpleasant gastrointestinal symptoms. They even sound similar.
According to the Crohn’s and Colitis Foundation, as many as 1.6 million Americans have an IBD. Getting the right diagnosis for whichever condition is essential for starting treatment, learning to manage symptoms and limiting the impact on your health and quality of life.
Ulcerative Colitis vs. Crohn’s Disease
Crohn’s disease and ulcerative colitis both fall under the umbrella of autoimmune disorders, says Dr. Maham Lodhi, an assistant professor in the department of internal medicine with the Rush Center for Crohn’s and Colitis at Rush University Medical Center in Chicago. “That’s when your body is mounting an inflammatory response against itself,” she explains.
Doctors called gastroenterologists sort out signs and symptoms of IBD to pinpoint the specific condition. Evaluation and diagnosis can include tests such as standard X-rays, barium X-rays, an MRI or CT imaging and endoscopic procedures.
Here are some of the main ways that colitis and Crohn’s disease differ:
Crohn’s can be extensive. “One of the big differences is that Crohn’s can occur anywhere in the GI tract from the mouth to the anus,” Lodhi says. “Crohn’s can occur at any depth. So it can be superficial or it also can be penetrating where it causes strictures and abscesses that could connect to different organs.” Bowel obstruction can result from strictures, or narrowing in the intestines.
Ulcerative colitis is more limited. A distinguishing feature of ulcerative colitis is that it’s confined to the large intestine, which encompasses your colon and rectum, says Dr. David Rubin, chief of gastroenterology and a professor of medicine with University of Chicago Medicine. “Crohn’s disease can occur anywhere – most commonly it’s the last part of the small intestine where it joins the large intestine.”
Bloody diarrhea is more likely with ulcerative colitis. Diarrhea is common with both types of IBD, but there are differences. “With colitis, a classic symptom is rectal bleeding and bloody diarrhea,” Lodhi says. “Whereas in Crohn’s, you probably don’t see bleeding.”
Anal fistulas are more likely with Crohn’s. “The deep ulcers of Crohn’s disease can cause narrowing of the bowel and they can also cause the bowel to literally burrow through into other organs nearby or into the skin,” Rubin says. “So 20 to 25 percent of people with Crohn’s disease will develop a manifestation in the anal area called perianal Crohn’s.” With this, he says, patients can develop fistulas, which are abnormal connections from the bottom of the rectum or the anal canal out to their skin.
Pain may be different. Abdominal cramping is a hallmark of ulcerative colitis. Sharper pain could signal Crohn’s disease related to intestinal blockage, severe inflammation of the intestines or other damage caused by the disease. Pain control is one reason people with Crohn’s disease may be hospitalized. Severe dehydration is another.
Surgery can eliminate ulcerative colitis. “The surgical (method) for colitis is to remove the disease by taking out the colon,” says Dr. Jeffrey Baumgardner, an assistant professor of gastroenterology at University of California–San Francisco. For patients with ulcerative colitis who need surgery, J-pouch surgery (or ileal pouch–anal anastomosis) may be an option, he says. For this procedure, surgeons create a small pouch inside the body at the end of the small intestine. This internal, surgically created pouch allows people to have apparently normal bowel movements. Waste can pass through the small intestine into the pouch and be eliminated through the anus, rather than through an opening in the abdominal wall. .
Crohn’s disease returns even with surgery. With Crohn’s, surgery may be needed for patients with severe symptoms to reduce complications. “The type of surgery most patients with Crohn’s have is a limited resection of a few inches of small intestine where the disease has been,” Rubin says. “After that’s done it essentially resets the disease.” That helps get symptoms under control to enable effective treatment, he explains. “But the fascinating part of Crohn’s disease is that it comes back right at the site of the surgery,” he adds. “If you remove 6 inches, 6 inches come back. And we don’t quite understand that.”
An oral drug was recently approved for ulcerative colitis. Biologic drugs such as Humira and Remicade are synthetic proteins used to suppress the immune system through targeted pathways for patients with IBD. Biologics are given either by an injection or intravenous infusion. A different type of drug, a “small molecule,” is now available in tablet form for one type of IBD. In mid-2018, the oral drug called Xeljanz, which was previously approved for rheumatoid arthritis patients, was also approved to treat ulcerative colitis.
What Colitis and Crohn’s Have in Common
Considerable overlap exists between colitis and Crohn’s. “Both conditions are of unknown cause,” says Rubin, who is chair-elect of the Crohn’s and Colitis Foundation’s national scientific advisory committee. “Both conditions tend to be chronic. Both conditions can be progressive if they’re not controlled and treated properly. Both conditions may require surgery.”
In addition, both conditions can have manifestations beyond the intestines, most frequently joint pain, Rubin says. “So 30 percent of people with Crohn’s and colitis have joint pain that goes along with their bowel inflammation. A smaller number may have skin, eye or kidney problems, as well.”
Here’s are some basic ways the conditions resemble each other:
Many symptoms are alike. “I just have diarrhea all the time.” “It wakes me up from my sleep.” “I can’t seem to gain weight no matter what I eat.” “I have bone or joint pain.” These are frequent complaints when people first come in to be evaluated, Lodhi says. There’s also a classic, painful skin rash that develops with IBD, she says. Constipation or bowel movement urgency are other shared indications. Patients may feel fatigued.
Diseases tend to be diagnosed in younger people. Crohn’s and ulcerative colitis tend to first appear among adolescents and younger adults, Lodhi says. However, the diseases also can develop in middle age or in children as young as 5, 6 or 7, she adds. “The earlier you’re diagnosed, the more aggressive of a disease course you’re going to have,” she says. “And the harder we work to preserve the intestines for as long as we can. That’s because we want to prevent these kids from needing any surgeries. That’s the goal – to keep them in remission as long as possible.”
Flare-ups come and go. Patients with Crohn’s and colitis often experience worse periods as symptoms flare, followed by inactive periods when symptoms ease or seem to disappear. “Remission means you have restitution or return to normal bowel function,” Rubin says. Reduction of inflammation and signs of intestinal healing are clinical components of remission. People can stay in remission for long periods and live full, active lives.
Nutrition can suffer. Nutritional deficiencies like low vitamin levels canshow up in people with either condition, Lodhi says. Patients may need to adjust how they eat during flare-ups. “When you’re in a flare, you’re not going to be able to absorb a very healthy, high-fiber diet,” she says. Instead, “You should be on a bland, low-fiber, low-residue diet so you can absorb nutrients easier.” However, she notes, once you’re in remission without any inflammation, “You should be on a higher-fiber, more like a Mediterranean diet that’s high in good fats like olive oil, olives, nuts and grains.”
Medications to treat conditions are similar. Although individual drugs may differ, a similar approach is used with Crohn’s and ulcerative colitis. For milder symptoms, drugs called aminosalicylates can help. For moderate to severe cases, steroids like prednisone suppress the immune system to reduce inflammation. However, short-term use is advised to avoid steroid complications. Immune-modifier drugs like cyclosporine can prevent ongoing inflammation. Antibiotics are used to treat disease-related infections. Biologics may work for some patients with persistent symptoms who don’t respond to other treatments.
Life expectancy is normal. Although inflammatory bowel disease causes significant complications, people can live well with good management. “Luckily, it doesn’t seem to affect your life expectancy,” Baumgardner says. “If you have symptoms of crampy, abdominal pain – especially if you’re younger and they come out of the blue – you should talk to your physician, as early diagnosis leads to early treatment.”
Communication is crucial. “Not everyone who has inflammatory bowel disease will have to have surgery, and that’s a very common misunderstanding,” Lodhi says. Building a trusting relationship with your gastroenterologist and learning more about your disease can help you advocate for yourself in making treatment decisions and preventing complications. For instance, she says, doctors should discuss sensitive subjects like family planning with young women patients early on.
Treatments keep improving. As the IBD field grows more complex and diagnosis becomes more precise, some patients may need a second opinion to make sure they have the clear, complete information they need, Rubin says. With advances in targeted treatments, he says, people should really know all the options they have: “There are some really amazing ones available.”