Inflammatory bowel diseases include ulcerative colitis and Crohn’s disease. Although these two conditions share similarities, they are quite different.
In this article, we’ll review their differences in symptoms and treatments.
Ulcerative Colitis vs Crohn’s Disease: An Overview
Both ulcerative colitis and Crohn’s disease cause inflammation along the digestive tract. However, Crohn’s disease tends to affect different parts of the track compared to ulcerative colitis. In most cases, Crohn’s disease affects the ileum. This is the last part of the small and large intestine. In as many as 45% of cases, the condition affects both the small and large intestines.
Crohn’s disease can occur in other parts of the digestive system, except for the rectum. But, infections and other complications of the anus can develop into Crohn’s disease.
Ulcerative colitis only affects the large intestine and the rectum is always involved. This condition occurs in the inner layer of the colon, or mucosa, in a continuous segment of the gut. Crohn’s disease can involve all four layers of the gut wall and often appears in patches.
Inflammatory bowel disease currently affects all ethnic groups. However, Crohn’s disease and ulcerative colitis are more prevalent in Caucasians. Specifically, people of Northern European, Anglo-Saxon, or Ashkenazi Jewish descent develop the condition. Hispanics and Asians are likely to have pancolitis, a form of ulcerative colitis that affects the entire colon.
The prevalence of inflammatory bowel diseases is on the rise. In the 1990s, two million people developed a condition. Currently, three million people worldwide live with Crohn’s disease or ulcerative colitis.
Cigarette smoking increases the risk of developing Crohn’s disease and worsens symptoms. It does appear to decrease the risk of ulcerative colitis, though. Contraceptives have also been shown to increase the risk of Crohn’s disease. Surgical removal of the appendix due to appendicitis may lower ulcerative colitis risks.
Non-steroid anti-inflammatory drugs (NSAIDs) and antibiotic use during childhood may increase the risk of both conditions.
Symptoms and Complications
While ulcerative colitis and Crohn’s disease are different conditions, they do share symptoms. These include:
- Chronic diarrhea
- Crampy abdominal pain
- Loss of appetite
- Weight loss
- Fever
- Blood in stool
Ulcerative colitis affects the rectum, leading to rectal bleeding. Other symptoms include the urge to defecate and the inability to have a bowel movement.
There are different classifications of ulcerative colitis depending on where it’s located.
Ulcerative Proctitis – This affects the rectum and rectal bleeding may be the only sign of it. When inflammation involves the rectum, we refer to the lower segment of the colon as proctosigmoiditis. Along with bloody diarrhea, people experience abdominal cramps and the inability to defecate.
Left-Sided Colitis – In this form of ulcerative colitis, inflammation affects the rectum, lower part of the colon, and descending colon. It causes occasional pain on the left side and other symptoms.
Pancolitis – The most severe form of the condition affects the entire colon. It causes severe bloody diarrhea, abdominal cramps, significant fatigue, weight loss, and loss of appetite.
Some individuals may experience complications with these conditions.
Complications for Crohn’s disease include:
- Intestinal obstruction, which may need surgery
- Ulcers of the intestinal wall
- Fistulas between the intestine and skin or intestine and other organs
- Abscesses
- Anal fissures
Complications of ulcerative colitis include:
- Severe bleeding
- Perforation of the colon
- Osteoporosis
- Rapid swelling of the colon (toxic megacolon)
Both of these conditions increase the risk of the following:
- Colon cancer
- Blood clots
- Nutrient deficiencies (A, D, E, K, B12, iron, calcium, magnesium)
- Dehydration
It’s important to note that these conditions can manifest outside the digestive tract. This looks like inflammation of the joints, skin, and eyes.
Treatments
There are many treatment options for those with ulcerative colitis and Crohn’s disease. Doctors may prescribe anti-inflammatory drugs like 5-Aminosalicylic acid for both. Corticosteroids can also help during flare-ups, but should not be used for maintenance.
Researchers are studying the benefit of probiotics for both conditions. They are also searching for special diets to aid in maintaining the conditions. There are some natural supplements to help manage Crohn’s disease and ulcerative colitis.
Anti-diarrheas, painkillers, iron, and multimineral/multivitamin supplements can also help. These will correct nutrient deficiencies in both conditions.
Crohn’s Disease Treatments
In cases of Crohn’s disease, doctors may recommend immunosuppressors like methotrexate. This is another option when corticosteroids, azathioprine, or 6-mercaptopurine do not work.
Other biologic agents used to treat Crohn’s disease include:
- Anti-TNF drugs
- Infliximab
- Adalimumab
- Certolizumab
These are often used after surgery to prevent recurrences. Some cases may require surgery in case of intestinal obstructions.
Antibiotics may also be helpful with Crohn’s disease.
Ulcerative Colitis Treatments
If corticosteroids do not affect ulcerative colitis, there are some different options. Individuals may take the following anti-TNF medications:
- Infliximab
- Adalimumab
- Golimumab
Antibiotics may be helpful in cases of toxic colitis, too.
Some individuals may need surgery to remove part of the colon as well.
Which Has a Better Prognosis?
Does Crohn’s disease or ulcerative colitis have a better prognosis? Overall, both conditions have a pretty good prognosis. The important thing is to manage the condition and avoid flare-up triggers.
Both conditions can be unpredictable at times. Some may consider ulcerative colitis worse than Crohn’s due to its severe forms and surgeries. These surgeries are riskier for individuals over the age of 50 due to postoperative complications.
Undetected and untreated cases of both conditions can also cause serious complications. These include colon cancer and effects on other organs.
