Ulcerative colitis vs crohn’s

What is the difference between Crohn’s disease and ulcerative colitis?

Both diseases respond well to a variety of treatments. These can include:

Medication

Both diseases can be controlled through the proper use of medications that target the body’s inflammatory responses. Reducing inflammation can reduce and eliminate many of the shared symptoms of the diseases, such as pain and diarrhea.

In addition to targeting symptoms, medication can also be used to decrease the frequency of flares, in what is known as maintaining remission. As proper treatment is administered over time, periods of remission can be extended, and periods of symptom flares can be reduced.

Both diseases have several types of medication that are available.

Combined therapies

In some circumstances, a doctor may recommend an additional therapy to the initial one to increase its effectiveness.

For example, combination therapy may add in biologics with an immunomodulator. As with all therapies, there are benefits and risks associated with combination therapy.

Combining therapies can increase the effectiveness in treating the diseases, but there may be an increased risk of side effects and toxicity.

Nutrition and diet plans

Share on PinterestKeeping a food journal and meal plan is recommended to monitor triggers and ensure that proper nutrition is maintained.

Both diseases have a tendency to reduce a person’s appetite. Foods are not responsible for causing either disease but people tend to find that modifying what they eat, based on what aggravates their symptoms, is helpful.

Diet modifications vary between individuals and disease. For example, a person with Crohn’s disease may find a bland diet is best during a flare and may eat foods that a person with ulcerative colitis would not be able to tolerate.

In both cases, proper nutrition is essential. So, people with either disease should keep a food journal and be aware of what upsets them.

Also, a meal plan can help an individual ensure they get enough nutrients. In either case, a doctor can help develop a meal plan that will avoid aggravating symptoms and provide adequate nutrition.

Surgery

This treatment varies in frequency and location between Crohn’s disease and ulcerative colitis.

Medical treatment is the mainstay for both Crohn’s disease and ulcerative colitis. Surgery is reserved for those cases where there are complications, such as perforation of the bowel, excessive bleeding, cancerous growth, or severe inflammation not controlled with medications. Crohn’s disease may eventually come back later in life after surgery. In contrast, the removal of the colon and rectum, which is done in the case of ulcerative colitis, is considered a cure, as the disease no longer has a place to reside.

Surgery for either disease has a number of potential risks and will require recovery time. A doctor should discuss with the individual the possible benefits and risks of surgery before recommending a procedure.

Ulcerative colitis and Crohn’s disease

People experience bowel problems all the time. The cause could be something they ate, stress, or something else. Most of the time these episodes pass, and you can get back to your regular life with no problem.

But for millions of people, constant bowel issues are a way of life. They suffer flare-ups that can last for weeks and cause pain, diarrhea, fatigue, bloody stools, loss of appetite, and weight loss. These episodes may go away for long periods and return with no explanation. They cause missed workdays and keep people from going out with friends. Even more frustrating for people with this problem is that they often don’t know why it happens or what they can do about it.

If this sounds familiar, you could be among the estimated 1.6 million to 3 million adults who suffer from inflammatory bowel disease, or IBD.

IBD is a collective term for diseases in which a faulty immune system triggers chronic inflammation in the digestive system. There are two main kinds of IBD: ulcerative colitis (UC) and Crohn’s disease.

These two conditions share many symptoms and risk factors, yet they are quite different. One difference is where they occur. UC affects only the large intestine (colon or large bowel). Crohn’s can affect any part of your gastrointestinal tract, though it most often involves the last part of the small intestine (ileum) and often the beginning of the colon (cecum). Also, UC occurs only in the inner lining of the colon (mucosa), while Crohn’s disease can involve all four layers of the intestinal wall. UC tends to affect a continuous section of the bowel, whereas Crohn’s often appears in patches.

Almost anyone can get UC or Crohn’s disease. They affect men and women about equally. Symptoms typically begin between the ages of 20 and 30. However, about 25% of IBD patients are teenagers or younger when diagnosed, and some may be in their 50s or 60s. IBD can even begin before age 10 or after age 70.

You cannot prevent IBD, nor can you cure it. No one knows exactly why someone gets it, although it tends to run in families. All this makes IBD challenging to diagnose and treat. And yet you don’t necessarily have to suffer with IBD for the rest of your life. The goal is to manage symptoms, reduce their severity, and, if possible, keep the disease in remission for long periods. When you are in clinical remission, symptoms go away. Treatment can help control or end inflammation, leading to remission.

As this report explains, there are many ways to manage IBD, primarily through medication and surgery. These treatments work together to soothe your symptoms, reduce flare-ups, and help you better cope with your condition. This report also provides insight into the possible causes and complications of IBD, how you are diagnosed, and the steps you can take for better care so you can live your best life.

Goals of care for IBD should include, at a minimum, clinical remission. Some studies suggest that people with IBD, even those in clinical remission, do better over the long term if a colonoscopy also shows healing inside the intestine. You and your doctor should discuss and decide on your individual goals. How long remission lasts depends on how you respond to treatments and how long you continue them. Remission can last for years.

Prepared by the editors of Harvard Health Publishing in conjunction with Adam Cheifetz, MD, Professor of Medicine,Harvard Medical School and Director, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center. (2019)

About Harvard Medical School Guides

Harvard Medical School Guides delivers compact, practical information on important health concerns. These publications are smaller in scope than our Special Health Reports, but they are written in the same clear, easy-to-understand language, and they provide the authoritative health advice you expect from Harvard Health Publishing.

Lifestyle changes. Those include diet tweaks, regular exercise, quitting smoking, and avoiding pain meds called “NSAIDs” (nonsteroidal anti-inflammatory drugs) such as ibuprofen.

Stress management is also key. Stress doesn’t cause IBD, but it can lead to flare-ups. So try to cut down on the things that make you tense, and find ways to relax. Exercise is a great way to do that. So are other healthy things you might enjoy and find meaningful, such as hobbies, meditation, prayer, volunteering, and positive relationships.

Medicines can get inflammation under control:

“5-ASAs” work on the lining of your GI tract to lower inflammation. They work best in the colon. You might take them to treat an ulcerative colitis flare, or as a maintenance treatment to prevent relapses of the disease.

Steroids curb the immune system to treat ulcerative colitis. Due to side effects, you probably wouldn’t stay on them for a long time.

For severe disease, you may need drugs that work on the immune system. These include:

With the treatments for mild symptoms, almost all — 90% — of ulcerative colitis cases go into remission. If your UC is “refractory,” you may need continuous treatment with steroids.

With Crohn’s disease, complete remission is less common.

Some people eventually need surgery. That includes up to 45% people with ulcerative colitis and three quarters of people with Crohn’s.

You and your doctor might talk about an operation if you have severe symptoms that aren’t helped by medications, if you get a blockage in your digestive tract, or if you get a tear or hole in the side of the intestine.

What’s the Difference Between Crohn’s Disease and Ulcerative Colitis?

Crohn’s, on the other hand, is often marked by nausea, weight loss, and vomiting, with only occasional rectal bleeding, and diarrhea. According to the Mayo Clinic, Crohn’s disease may also cause mouth sores or inflammation of the eyes, joints, and skin.

According the the Crohn’s and Colitis Foundation, around 10 to 15 percent of people who suffer from an IBD have what’s called indeterminate colitis and display symptoms related to both Crohn’s and ulcerative colitis, which can lead to a misdiagnosis. It’s important to speak up if you don’t believe your symptoms are improving under your current treatment.

2. Where Inflammation Occurs

Both illnesses are caused by inflammation in the GI tract, but where the inflammation occurs can lead a doctor to the correct diagnosis. “The most basic difference is that Crohn’s disease can involve the entire GI tract, from the mouth all the way down to the anus, whereas ulcerative colitis is restricted to the colon,” says Louis Cohen, MD, assistant professor of gastroenterology at Icahn School of Medicine at Mount Sinai in New York City.

According to the UCLA Center for Inflammatory Bowel Disease, Crohn’s disease usually results in healthy stretches of the intestine between inflamed areas. People who suffer from colitis experience continuous inflammation of the colon.

3. Diagnostic Tests

Doctors may inspect a stool sample for signs of mucus or blood, which could be indicative of UC. Stool samples can also help doctors rule out other issues, like pathogens or bacteria.

The gold standard for diagnosing IBD is the colonoscopy — a small camera that’s attached to a thin tube that’s inserted into the colon — which allows a doctor to see the entire colon and take a biopsy of inflamed tissue. If the doctor sees that the inflammation starts at the rectum and moves continuously up the colon and then stops, this could be a sign of ulcerative colitis.

In Crohn’s, inflammation can occur anywhere in the digestive tract, and there are typically patches of healthy tissue interspersed with patches of inflamed tissue. In some cases, Crohn’s may involve just the rectum and some of the colon, so the pathology report on the biopsied tissue can help make that diagnosis.

Crohn’s sometimes creates clusters of immune cells called granulomas, whereas ulcerative colitis does not. Granulomas are the result of your body’s attempt to get rid of foreign material, and the cells are visible under a microscope, according to the Crohn’s and Colitis Foundation. If the doctor suspects that the small intestine is involved in Crohn’s, she or he can use an imaging, including a magnetic resonance imaging (MRI) or CT scan, to get a better look. If part of the upper GI tract, like the esophagus, is involved, your doctor may perform an upper endoscopy to determine where the inflammation is.

Treating Crohn’s and Colitis

It’s important to know that neither Crohn’s nor ulcerative colitis can be cured, though doctors will work with patients to manage symptoms. The two illnesses are generally treated with the same types of medication, although each patient may respond differently to the same drug. The goal of treatment is to reduce the inflammation, which in turn reduces symptoms, allows your body to repair damaged tissue, and helps slow the progression of the disease.

Today, many patients get a relatively new class of drugs, called biologics, which are live antibodies that are given to patients to help their immune cells fight the inflammation. Other classes of drugs include immunomodulators, which help tamp down the immune system’s inflammatory response, and aminosalicylates, the oldest class of drugs, which are used to help keep the disease in remission. According to the Crohn’s and Colitis Foundation, immunomodulators can take up to six months to become fully effective, so doctors usually prescribe them along with fast-acting steroids that patients will ideally go off of once the immunomodulators reach their full potential. “I absolutely think that with these new drugs, it’s a new era in the treatment of inflammatory bowel disease,” says Dr. Cohen.

Diet is also an important factor in managing flare-ups of both diseases. High-fiber vegetables like broccoli and cauliflower, uncooked produce, and unpeeled fruit are foods that people with IBD have difficulty digesting. Dairy and fatty or greasy foods can also trigger symptoms. Try eating cooked vegetables, nut butters instead of whole nuts, and lean meats and fish. But each body is different. Working with a dietitian can help you determine which foods you should avoid

When Surgery Is Needed

If medication isn’t reducing the inflammation and IBD progresses, surgery may be needed. This is where people with ulcerative colitis tend to fare better.

“If the colon gets bad enough in ulcerative colitis, it’s removed and replaced with an internal pouch, which functions like a colon,” says Cohen. According to the Mayo Clinic, colectomy surgery — whether partial or full — usually requires additional procedures that reconnect the remaining portions of the digestive system so they can still rid the body of waste.

However, things are looking up. A study published in December 2019 in the Journal of Gastrointestinal Surgery found that due to advances in medicine and medical care for IBD patients over the past decade, the number of hospitalized patients with ulcerative colitis who require a colectomy decreased by nearly 50 percent between 2007 and 2016.

According to the Crohn’s and Colitis Foundation, proctocolectomy with ileal pouch–anal anastomosis — usually called J-pouch surgery — is the most common surgery performed on people with UC who have not responded to medication. Surgeons remove the rectum and colon and then create a temporary opening in the abdomen, called a loop ileostomy, which will allow waste to move from the small intestine into an ostomy bag that sits outside the body while the digestive system heals from the surgery. In some cases a stoma, or permanent opening in the abdomen that funnels waste into an external bag, is required, notes the Mayo Clinic.

Since Crohn’s can occur anywhere in the digestive tract, simply removing the colon won’t cure the disease. According to the Cleveland Clinic, 70 to 80 percent of people with Crohn’s disease will eventually require surgery. Typically in people with Crohn’s, smaller pieces of the colon will be removed to try and preserve as much of the healthy intestines as possible. This requires more frequent surgeries.

In severe cases, Crohn’s can cause tears or holes in the bowel, causing a fistula, or a tunnel that leads from one section of the bowel to another. Fistulas are serious and need to be repaired. About one-half of Crohn’s patients will require surgery within 10 years of diagnosis, compared with about 10 to 30 percent of adults with ulcerative colitis. But treating both Crohn’s and ulcerative colitis early and effectively may slow the progression of the diseases, and delay the need for surgery.

Additional reporting by Kaitlin Sullivan.

Crohn’s Disease vs. Ulcerative Colitis

Ulcerative colitis and Crohn’s disease are inflammatory bowel diseases (IBD) that affect the gastrointestinal tract. However, it’s important to distinguish between these conditions, as they require different therapies. Early and accurate diagnosis of your digestive condition can lead to faster treatment, which results in better outcomes and a reduced risk of hospitalization, surgery and other serious complications.

Similarities

There are many similarities between ulcerative colitis and Crohn’s disease – so many, in fact, that the two conditions sometimes seem interchangeable to many individuals. Similarities between these IBD conditions include:

  • Long-term inflammation of the digestive tract
  • Digestive discomfort and symptoms, such as:
    • Stomach cramps and pain
    • Diarrhea
    • Constipation
    • Urgent need to have a bowel movement
    • Feeling as though your bowel movement was incomplete
    • Rectal bleeding
    • Loss of appetite
    • Weight loss
    • Fatigue
    • Night sweats
    • Irregular periods
  • More likely to affect teenagers and young adults
  • More likely to run in families
  • Diagnosed with a colonoscopy

Differences

While there are several similarities between Crohn’s and ulcerative colitis, key differences set these conditions apart – and call for different treatment approaches. Differences between these IBD conditions include:

  • Location of inflammation – Ulcerative colitis only occurs in the colon, but Crohn’s disease can occur anywhere along the digestive tract.
  • Degree of inflammation – Ulcerative colitis causes consistent inflammation along the entire colon, compared Crohn’s disease that causes intermittent inflammation around healthy tissue.
  • Unique symptoms – Ulcerative colitis and Crohn’s disease are each more likely to cause certain symptoms. For example, individuals with ulcerative colitis may experience rectal bleeding or blood in stools more often than individuals with Crohn’s. Additional and unique symptoms of Crohn’s disease include mouth sores, anal tears, ulcers, infections and narrowing of the intestine.

Treatment Options

The primary goal of treatment for Crohn’s disease and ulcerative colitis is to reduce inflammation. Your gastroenterologist will work closely with you to develop a treatment plan that addresses inflammation, helps manage symptoms and reduces flare-ups.

Treatment plans will vary based on your specific condition and the severity of inflammation and symptoms. Generally, Crohn’s and ulcerative colitis are managed with a combination of medication and diet and lifestyle modification. In some cases, when a nonsurgical approach fails to address your condition, your gastroenterologist may recommend surgery.

Learn more about treating Ulcerative colitis or Crohn’s disease.

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