Crohn’s Disease vs Ulcerative Colitis – What Are the Key Differences?

Crohn’s disease and ulcerative colitis are painful types of inflammatory bowel disease that affect thousands of Australians. Although there are many similarities in the way that these two conditions present in the body and the believed causes, there are also key differences between them. Doctors will use a range of diagnostic tests to determine which disease a patient is suffering from and tailor their treatment and disease management accordingly. 

What Is Crohn’s Disease? What Is Ulcerative Colitis?

Crohn’s disease is a type of inflammatory bowel disease (IBD) that causes inflammation of your digestive tract. It can result in painful and dangerous symptoms, including abdominal pain, severe diarrhoea, fatigue, weight loss and malnutrition. 

Ulcerative colitis is a similar condition that is also classed as inflammatory bowel disease and which also causes digestive tract inflammation, as well as ulcers or sores in the large intestine and the rectum.

Crohn’s disease and ulcerative colitis collectively affect more than 75,000 Australians, with most people receiving a diagnosis before turning thirty. 

Effects of Crohn’s Disease and Ulcerative Colitis

Both of these debilitating conditions present a range of uncomfortable symptoms, which can cause serious problems for sufferers. Most of the time, the symptoms of Crohn’s disease and ulcerative colitis develop over time rather than suddenly. Most people will have mild to moderate symptoms, and it is possible to have long periods of remission when patients are unbothered by discomfit and pain.

Signs and Symptoms

Most people with Crohn’s disease and ulcerative colitis will only present symptoms when the condition is active (or they are not in remission). Some of the common symptoms include:

•     Pain in the abdomen
•     Weight loss
•     Diarrhoea (sometimes with blood and mucus)
•     Tiredness
•     Constipation
•     Urgency to defecate
•     Fever
•     Rectal pain
•     Rectal bleeding
•     Reduced appetite
•     Malnutrition
•     Nausea.

When Crohn’s disease and ulcerative colitis affect children, it can result in delayed or impaired growth.

Causes of Crohn’s Disease and Ulcerative Colitis

The causes of these diseases remain unknown. In the past, doctors believed that a combination of poor diet and stress was the cause of Crohn’s disease and ulcerative colitis. Today, it is recognised that while these factors can aggravate the conditions, they are not the cause.

There are two main theories for why people develop Crohn’s disease and ulcerative colitis. The first is that it is caused by a defect in the body’s immune system. It is possible that this happens when the body attempts to fight off infection from a bacterium or virus. When your immune system tries to fight off the invading microorganism, an abnormal immune response causes the immune system to attack the cells in the digestive tract. More research is required to determine if this is the case.

The second theory is that Crohn’s disease and ulcerative colitis are genetic conditions. Although they are seen more commonly in people who have family members with the disease, the majority of sufferers do not have a family history of either Crohn’s disease or ulcerative colitis. 

Risk Factors of Crohn’s Disease and Ulcerative Colitis 

Although doctors aren’t sure of the exact cause of Crohn’s disease and ulcerative colitis, research has indicated that there are some risk factors for the conditions:

•     Age – Although they can occur at any age, you’re more likely to develop Crohn’s disease or ulcerative colitis when you’re young. Most people are diagnosed before they are thirty.
•     Ethnicity – Crohn’s disease has been shown to be more prevalent in the Caucasian race, especially people of Eastern European (Ashkenazi) Jewish descent. However, the incidence of Crohn’s disease is increasing among other ethnic groups.
•     Family history – 1 in 5 people with these conditions has a family member with the disease, and you are at particularly higher risk if you have a parent, sibling or child with the disease.
•     Cigarette smoking – Smoking can increase your risk of developing these conditions and will also make your symptoms worse and more difficult to treat.
•     Non-steroidal anti-inflammatory medications – Medications such as ibuprofen, naproxen sodium, and diclofenac sodium can lead to inflammation of the bowel. This makes Crohn’s disease and ulcerative colitis worse.

Diagnosis of Crohn’s Disease and Ulcerative Colitis

A variety of tests are used to diagnose and monitor Crohn’s disease and ulcerative colitis. Many tests will be used to determine that a patient has an inflammatory bowel disease, with further investigation needed to clarify if they are suffering from Crohn’s disease, ulcerative colitis, or another condition. Diagnosis will also aim to determine the extent and severity of the disease.

Blood Tests

Crohn’s disease and ulcerative colitis cannot be diagnosed through blood tests alone, but they do form an important part of diagnosis and can also be used to monitor the activity of the disease. Some of the things doctors can determine from blood tests include complete blood count (CBC), inflammation markers, levels of vitamin B-12 (which are low if the small intestine isn’t working properly), and levels of electrolytes.

X-Rays

An X-ray of the abdomen can help to discover inflammation of the intestines, as well as find other causes for discomfit such as an intestinal blockage. 

CT Scan 

CT scans, or Computerised Tomography scans, are a type of scan that uses x-ray from multiple angles to create a complete picture of what is going on inside the body. They are mainly used to detect complications of Crohn’s disease and ulcerative colitis, including abscesses, fistulas, and intestinal blockages. 

Endoscopy

Endoscopy uses a thin, flexible tube called a scope to explore parts of the gastrointestinal tract. Patients are sedated to allow doctors to insert the scope into their mouth or rectum. There are different types of endoscopy that may be used to diagnose Crohn’s disease and ulcerative colitis, including a Colonoscopy (which examines the lining of the entire large intestine) and a Sigmoidoscopy (which examines the lining of the lower third of the large intestine).  

Treatment for Crohn’s Disease and Ulcerative Colitis

There are a variety of treatment options for Crohn’s disease and ulcerative colitis. Using a combination of these can help to manage the disease and give patients a good quality of life. Treatment for different types of inflammatory bowel conditions can include the use of medication, changes to diet and nutrition, and surgical procedures.

Medication

Crohn’s disease and ulcerative colitis are caused by an abnormal inflammatory response by your body’s immune system. Medication, such as steroid or cortisone-based medication, can be used to suppress this response and offer relief from the symptoms caused by inflammation, such as fever, pain, and diarrhoea. The use of medication will also allow the tissue inside the intestinal tract to heal over time, increasing a patient’s chance of entering remission for the disease. There are a few types of medication being used to treat Crohn’s disease and ulcerative colitis, and sufferers should work with their healthcare professionals to determine which options are best for them to reduce the chance of flare-ups. 

Surgery

Surgery for Crohn’s disease and ulcerative colitis can become necessary if the conditions are no longer being controlled by medication. This is the case for about one-fifth of all sufferers of the disease. Surgery often involves the removal of the diseased segment of the bowel (resection), and then the two ends of the healthy bowel are joined together (anastomosis). Surgery is not considered a cure for any form of IBD, but it can conserve portions of the gastrointestinal tract. Although many patients do experience a higher quality of life after surgery, around one third will require the operation again later in life.

Diet

When you are diagnosed with Crohn’s disease or ulcerative colitis, your doctor will usually recommend changes to your diet to help manage the condition. A specialised diet can help to reduce the severity and frequency of flare-ups, promote healing in the intestines, and replace nutrients that are lost through symptoms like diarrhoea. 

Crohn’s disease and ulcerative colitis, as well as the medications used to treat these conditions, often reduce your appetite while increasing your body’s energy needs. This means that patients must ensure they are meeting their nutritional requirements by eating a variety of foods. Working with a dietitian can help to determine which foods should be avoided; usually, spicy and high-fibre foods can cause added discomfit, while soft and bland foods can assist in managing symptoms.

Some of the dietary changes that are often recommended for a person with any form of IBD include:

•     Low-fibre diet 
•     Low-fat diet
•     Low-lactose diet
•     Liquid diet
•     Increased intake of water.

3 Key Differences Between Crohn’s Disease and Ulcerative Colitis

While the conditions are very similar and share a lot of characteristics, there are three main differences between Crohn’s disease and ulcerative colitis.

Symptoms

Many of the symptoms of IBD are shared between both diseases, but there are some key symptoms that are more likely to occur in each. Taking note of your individual symptoms is important; you can share this information with your doctor, who will use this to help with your diagnosis.

Ulcerative colitis is often characterised by blood and mucus in the stool, frequent diarrhoea, loss of appetite, and tenesmus, or a strong urge to use the bathroom without necessarily having a bowel movement.

Crohn’s disease, on the other hand, is often marked by nausea, weight loss, and vomiting, with only occasional rectal bleeding and diarrhoea. Additionally, people suffering from Crohn’s disease will often experience inflammation of the skin, eyes and joints, inflammation of the liver or bile ducts, kidney stones and anemia (or an iron deficiency). 

Inflammation Location

There are some differences in where inflammation occurs between Crohn’s disease and ulcerative colitis. Although both illnesses are caused by inflammation in the GI tract, Crohn’s disease can involve the entire GI tract, from the mouth all the way down to the anus. In ulcerative colitis, inflammation is restricted to the colon specifically. Determining the location of the inflammation through diagnostic tests can help doctors decide which type of condition a patient has.

Diagnostic Tests

Doctors will use different diagnostic tests to determine if a patient has Crohn’s disease or ulcerative colitis. Some tests are more helpful in diagnosing one condition than the other. For example, Crohn’s disease may involve just the rectum and some of the colon, so the pathology report on the biopsied tissue can help make the diagnosis. Additionally, Crohn’s disease sometimes creates clusters of immune cells called granulomas, whereas ulcerative colitis does not.

During a colonoscopy, 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.

Where to Get Help

If you are suffering from some of the symptoms associated with IBD, it is important to seek assistance from your doctor as soon as possible. They will typically refer you to a specialist, called a gastroenterologist, who can conduct the necessary tests to give you a formal diagnosis and begin the process of managing your condition.

Often, management of Crohn’s disease or ulcerative colitis will involve a team of healthcare professionals, including your GP and a dietitian who can support you to make better food choices.

When you have been diagnosed with a health condition, it can be helpful to speak to other people who are living with this disease and their carers. You can find support for IBD suffers through IBD Support Australia – [email protected].

Sometimes people with Crohn’s disease or ulcerative colitis will require additional assistance or nursing care at home. Homage’s teams of Care Professionals can provide both personal care and home nursing services which make maintaining a good quality of life much easier. During an IBD flare-up, they can assist with things like toileting, bathing, eating, administering medication, and transport to medical appointments. 

For emergency cases, call Triple Zero (000) and arrange the fastest way to the closest emergency room.

Crohn’s disease and ulcerative colitis both require comprehensive management to avoid the painful and debilitating symptoms associated with these conditions. If you suspect you have a type of inflammatory bowel disease, it is important that you seek help right away. 

Need some assistance with care for yourself or your loved one? Find out how Homage can help!