Understanding the differences between ulcerative colitis and Crohn’s disease is vital for developing an effective treatment plan. Prolonged use of cathartics, especially Piel, over many years can lead to a condition called cathartic enteropathy. Other conditions to consider include lymphocytic colitis, which rarely requires surgery and has a low risk of cancer, as well as infectious colitis, ischemic colitis in older adults, and radiation-induced colitis.

Radiological findings in severe infectious enterocolitis, caused by infections like Entamoeba histolytica (amebiasis), cytomegaloviral colitis, or bacterial infections such as Salmonella, Shigella, or Yersinia, may resemble those seen in ulcerative colitis, especially on CT scans

Ulcerative colitis and Crohn’s disease present distinct characteristics that aid in their differentiation.

Grossly, Crohn’s disease is typically discontinuous and lacks an identifiable infectious cause. In Crohn’s patients, areas of normal mucosa are interrupted by ulcerations throughout the gastrointestinal tract. The gastric mucosa in Crohn’s disease often displays a thready appearance, leading to the classic cobblestone appearance.

Crohn’s disease can involve the entire gastrointestinal system, while ulcerative colitis primarily affects the large bowel, particularly the colon and rectum. Microscopically, both conditions exhibit colon swelling, presenting a similar endoscopic picture. However, granulomas, found only in Crohn’s disease, are specific to this condition, occurring in around 60% of patients.

The inflammation associated with Crohn’s disease may extend through the entire bowel wall (transmural), whereas in ulcerative colitis, it is typically limited to the mucosa and submucosa. Unfortunately, preoperative differentiation between the two is often challenging, with some patients initially diagnosed with ulcerative colitis later being diagnosed with Crohn’s disease postoperatively.

The notion that ulcerative colitis only affects the large bowel is being reconsidered, as significant gastroduodenal inflammation has been observed in children with the condition. However, aphthous ulceration of the mouth is considered distinctive to Crohn’s disease. Additionally, patchiness of the colon mucosa, suggestive of transmural lesions, may occur during the course of ulcerative colitis treatment, leading to diagnostic challenges. Anal sparing may also occur in approximately 50% of ulcerative colitis patients during treatment.

Proximal disease manifestation may occur even after proctocolectomy. Capsule endoscopy has revealed patchy inflammation in the proximal bowel in patients with chronic proctitis following proctocolectomy with ileal pouch-anal anastomosis

Ulcerative Colitis:

1. Specific Signs and Symptoms:
   • Rectal bleeding, often with bright red blood
   • Urgency to have a bowel movement
   • Diarrhea, often with blood or pus
   • Abdominal cramps and pain, usually in the lower abdomen
   • Tenesmus, a constant feeling of needing to pass stools despite emptying the bowel
2. Non-specific Signs and Symptoms:
   • Fatigue
   • Weight loss
   • Loss of appetite
   • Fever
   • Anemia

Ulcerative Colitis is characterized by specific signs such as rectal bleeding, urgency to have a bowel movement, diarrhea often with blood or pus, abdominal cramps and pain mainly in the lower abdomen, and tenesmus, a constant urge to pass stools despite emptying the bowel. Additionally, patients may experience non-specific symptoms like fatigue, weight loss, loss of appetite, fever, and anemia.

Crohn’s Disease:

1. Specific Signs and Symptoms:
   • Abdominal pain and cramping, typically in the lower right abdomen
   • Diarrhea, sometimes bloody
   • Mouth sores
   • Perianal disease, including fistulas, fissures, and abscesses
   • Bowel obstruction
2. Non-specific Signs and Symptoms:
   • Fatigue
   • Fever
   • Weight loss
   • Loss of appetite
   • Joint pain and swelling

Crohn’s Disease presents specific signs such as abdominal pain and cramping, typically in the lower right abdomen, diarrhea, sometimes bloody, mouth sores, perianal disease including fistulas, fissures, and abscesses, and bowel obstruction. Non-specific symptoms may include fatigue, fever, weight loss, loss of appetite, and joint pain and swelling. Recognizing these specific and non-specific signs and symptoms can aid both patients and healthcare professionals in distinguishing between ulcerative colitis and Crohn’s disease, facilitating accurate diagnosis and appropriate treatment strategies.

Verified by: Dr.Diab (March 24, 2024)

Citation: Dr.Diab. (March 24, 2024). Crohn’s disease and Ulcerative colitis differencial diagnosis. Medcoi Journal of Medicine, 7(2). urn:medcoi:article1091.