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

Symptoms of Crohn's disease and ulcerative colitis that are similar include: 

• Persistent diarrhea (may be bloody)
• Rectal bleeding
• Urgent need to have a bowel movement
• Abdominal cramps and pain 
• Feeling of incomplete bowel evacuation
• Constipation (may lead to bowel obstruction)
• Weight loss
• Fatigue
• Fever
• Night sweats
• Loss of appetite
• Bloating
• Nausea
• Vomiting

Crohn’s disease can also cause symptoms in the body outside the GI tract, including: 

• Eye problems
  • Redness 
  • Pain in the eyes
  • Vision changes
• Mouth sores
• Joint pain and swelling
• Skin complications
  • Bumps
  • Rash
  • Sores
• Changes in menstrual cycle
• Osteoporosis
• Kidney stones
• Liver problems such as primary sclerosing cholangitis and cirrhosis (rare)

Additional symptoms of ulcerative colitis may include:

• Rectal pain 
• Dehydration 

For both conditions, relapses, when inflammation and symptoms worsen (flares) can occur, followed by periods of remission that can last months to years when symptoms subside.

Crohn’s disease and ulcerative colitis are diagnosed with a patient history and physical examination, along with tests that may include: 

• Stool testing
  • To rule out infection and parasites
  • Calprotectin
• Blood tests 
  • Complete blood count (CBC)
  • Iron studies
  • C-reactive protein 
  • Sedimentation rate 
  • Kidney function
  • Liver function tests
• X-rays of the upper and lower GI tract
• Barium enema X-ray 
• Endoscopy
  • Colonoscopy
    • Chromoendoscopy: may be performed during a colonoscopy to check for polyps or precancerous changes.
  • Upper endoscopy
  • Sigmoidoscopy
  • Video capsule endoscopy 
• Small intestine imaging
  • Fluoroscopic X-ray
  • Computed tomography (CT) scan 
  • Magnetic resonance imaging (MRI) scan
  • CT/MRI enterography
• Tissue biopsy

Treatment for Crohn’s disease and ulcerative colitis depends on the severity of the condition and how often a patient’s symptoms flare-up (worsen). Treatment is aimed at reducing symptoms, inducing remission (which is a period without symptoms), and maintaining remission.

Medications used to treat Crohn’s disease and ulcerative colitis include:

• 5-aminosalicylic acids (5-ASAs)
  • Mesalamine (Asacol, Pentasa, Rowasa, Lialda, Apriso)
  • Olsalazine (Dipentum)
  • Balsalazide (Colazal)
• Systemic corticosteroids
  • Prednisone
  • Prednisolone
  • Methylprednisolone
  • Cortisone
• Topical corticosteroids
• Immunomodulators
  • Azathioprine/6-MP (Imuran, Azasan)
  • Methotrexate (Trexall, Otrexup)
  • Tacrolimus (Prograf)
  • Cyclosporine (Sandimmune, Neoral)
• Biologic/Biosimilar Therapies
  • Infliximab (Remicade) (biosimilars: Infliximab-abda, infliximab-dyyb, infliximab-qbtx, and infliximab-axxq)
  • Adalimumab (Humira)
  • Golimumab (Enbrel)
  • Vedolizumab (Entyvio)
  • Certolizumab pegol (Cimzia) (Crohn’s disease)
  • Natalizumab (Tysabri) (Crohn’s disease)
  • Ustekinumab (Stelara) (Crohn’s disease)
• Janus kinase inhibitors (JAK Inhibitors) for ulcerative colitis
  • Tofacitinib (Xeljanz)
• Antibiotics for Crohn’s disease
  • Metronidazole (Flagyl)
  • Ampicillin (Principen)
  • Ciprofloxacin (Cipro)

Diet changes used to manage Crohn’s disease and ulcerative colitis include:

• Maintain good nutrition 
• Consume soft, bland foods during flares
• Avoid spicy or high-fiber foods during flares
• Restricting dairy intake if you are lactose-intolerant

Surgery used to treat Crohn’s disease includes:

• Strictureplasty: repairs a narrowing (stricture) by widening the narrowed area without removing any portion of the intestine
• Proctocolectomy: removal of the colon and rectum
• Colectomy: removal of the colon
• Fistula removal
• Bowel resection: removes a portion of the small or large intestine damaged by Crohn’s disease
• Abscess drainage

Surgery for ulcerative colitis is a last-resort used for severe cases. Surgery usually involves removing the entire colon and the rectum, which is the only permanent cure for ulcerative colitis.