How is Crohn disease differentiated from ulcerative colitis?

Updated: Jul 26, 2019
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

Patients with Crohn disease frequently present with abdominal pain, nonbloody diarrhea, weight loss, fever, and, sometimes, obstructive symptoms such as nausea, early satiety, and vomiting. World Health Organization diagnostic criteria for Crohn disease include the following [57] :

  • Discontinuous or segmental lesions as well as a cobblestone appearance or longitudinal ulcer noted on radiologic studies, endoscopy, and resected specimens
  •  Transmural inflammation, as evidenced by clinical evaluation, radiologic studies, biopsy findings, and resected specimens
  • Noncaseating granulomas, as revealed on biopsy findings and resected specimens
  • Fissures and fistulas, as evidenced by clinical evaluation, radiologic studies, and resected specimens
  • Perianal disorders on clinical evaluation

A variety of intestinal manifestations and extraintestinal manifestations (EIMs) also may be observed in conjunction with either Crohn disease or ulcerative colitis. Features differentiating the two forms of inflammatory bowel disease (IBD) are summarized in Table 1, below.

Table 1. Characteristics Differentiating Crohn Disease and Ulcerative Colitis (Open Table in a new window)

Characteristic

 

Crohn Disease

Ulcerative Colitis

Distribution

Entire gastrointestinal tract

Colon only, though gastritis is recognized

Skip lesions

Continuous involvement proximally from rectum

Pathology

Full thickness

Mucosa only

Granulomas (15-30% in biopsy specimens; 40-60% in surgically resected bowel)

No granulomas

Radiology

Entire gastrointestinal tract

Colon only

Skip lesions

Continuous involvement proximally from rectum

Fistulae, abscesses, fibrotic strictures

Mucosal disease only

Cancer risk

Increased

Estimated to be 3% at 10 years, 8% at 30 years, and 18% at 30 years after diagnosis [47] ; risk is higher in patients with primary sclerosing cholangitis and long-standing colitis (> 8-10 y); may be lower in subsequent studies (see Intestinal Manifestations).

Presentation

 

Crohn Disease

Ulcerative Colitis

Bleeding

Occasional

Very common

Obstruction

Common

Uncommon

Fistulae

Common

None

Weight loss

Common

Uncommon

Perianal disease

Common

Rare


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