Ulcerative Colitis and Crohn’s Disease - Symptoms, Differences, Diagnosis, and Treatment

Introduction

Ulcerative colitis and Crohn's disease are two types of chronic inflammatory bowel diseases (IBD) that affect the digestive system. Ulcerative colitis is a health condition characterized by inflammation and the development of ulcers in the lining of the colon and rectum. It typically affects the rectum and may spread continuously to other parts of the colon. Typical indications of ulcerative colitis consist of the following:

1. Pain in the abdomen.

2. Discharge of bloody stool.

3. Bleeding from the rectum.

In contrast to ulcerative colitis, Crohn's disease has the ability to impact any portion of the digestive system, from the oral cavity to the anus, and produces inflammation that extends beyond the intestinal lining. This ailment can result in various symptoms, such as fever, abdominal discomfort, diarrhea, and weight loss. In addition, Crohn's disease can also bring about complications like abscesses, fistulas, and strictures.

While the exact causes of ulcerative colitis and Crohn's disease are not fully understood, it is thought that they result from an abnormal immune response that targets the digestive system. Both conditions are chronic, meaning that they require long-term management to control symptoms and prevent complications.

What Are the Common Symptoms of Ulcerative Colitis and Crohn's Disease?

Symptoms of Crohn's disease and ulcerative colitis can be similar:

• Belly cramps and pain.

• Diarrhea.

• Constipation.

• A sudden and compelling requirement to defecate.

• Feeling like one’s bowel movement is not complete.

• Rectal bleeding.

• Fever.

• Smaller appetite.

• Weight loss.

• Fatigue.

• Night sweats.

• Menstrual irregularities, such as missed periods or unpredictable timing.

The symptoms of these conditions can vary and may not be present all the time, with periods of symptom exacerbation (flares) and remission. Crohn's disease and ulcerative colitis are most commonly diagnosed in teenagers and young adults, but they can occur at any age and often have a familial predisposition.

What Is the Difference Between Them?

There are three main differences:

• Location: Ulcerative colitis causes inflammation and ulcers only in the large intestine.

Crohn's disease can cause inflammation anywhere in the digestive tract, ranging from the mouth to the anus.

• Continuous Inflammation: Ulcerative colitis causes continuous inflammation of the colon and rectum. Crohn's disease can cause inflammation that extends through the intestinal wall, leading to complications such as strictures, fistulas, and abscesses.

• Layers Affected: In Crohn's disease, inflammation can affect all layers of the intestinal wall, from the innermost lining to the outermost layers. Ulcerative colitis, on the other hand, typically only affects the innermost lining of the colon and rectum.

How to Get the Right Diagnosis?

As the location of inflammation in the digestive system is the primary factor that distinguishes between Crohn's disease and ulcerative colitis, doctors will perform an internal examination to accurately diagnose the condition. Diagnostic tests that may be ordered include:

• X-rays to detect narrow or obstructed areas in the intestine.

• Contrast X-rays, which involve swallowing a barium solution to help visualize the digestive tract.

• CT scans and MRIs to rule out other conditions that may cause symptoms similar to those of inflammatory bowel disease.

• Endoscopy is a medical procedure that involves using a small camera attached to a thin tube to visually inspect the digestive system. Depending on the specific type of endoscopy, the following procedures may be performed:

1. Sigmoidoscopy: An endoscopic exam that focuses on the lower portion of the large intestine.

2. Colonoscopy: An endoscopic exam that allows for a full inspection of the entire large intestine.

3. Esophagogastroduodenoscopy (EGD): An endoscopic exam that examines the lining of the esophagus, stomach, and duodenum.

4. Capsule Endoscopy: A type of endoscopy that involves swallowing a small camera capsule to examine the small intestine.

5. Endoscopic Retrograde Cholangiopancreatography (ERCP): An endoscopic exam that focuses on the bile ducts in the liver and pancreatic duct.

Scientists are currently working on developing better blood tests to help diagnose ulcerative colitis and Crohn's disease. These tests measure the levels of certain antibodies, including pANCA (perinuclear antineutrophil antibodies) and ASCA (anti-saccharomyces cerevisiae antibody), in the blood. Typically, individuals with ulcerative colitis will have pANCA antibodies, while those with Crohn's disease will have ASCA antibodies. However, the accuracy of these tests is still uncertain, and they should only be used along with other diagnostic procedures. In some cases, even after extensive testing, doctors may not be able to determine whether a patient has Crohn's disease or ulcerative colitis. About 1 in 10 people with IBD exhibit symptoms of both conditions and they receive a diagnosis of "indeterminate colitis" due to the unclear nature of their condition.

How to Find the Right Treatment?

Since ulcerative colitis and Crohn's disease share many similarities, treatments for these conditions often overlap. The following treatments are helpful for both:

• Lifestyle Changes: Modifying one’s lifestyle can help manage both ulcerative colitis and Crohn’s disease. These changes may include adjusting the diet, regular physical activity, giving up smoking, and avoiding pain relievers like Ibuprofen, which are classified as “NSAIDs” (nonsteroidal anti-inflammatory drugs).

Reducing stress is also critical since it can exacerbate symptoms. Although stress is not a cause of IBD, it can trigger flare-ups. Therefore, it is necessary to reduce stress by identifying and limiting stressful triggers and finding ways to relax. Exercise is an excellent way to accomplish this, as are other healthy activities that one enjoys and finds meaningful, such as hobbies, meditation, prayer, volunteering, and nurturing positive relationships.

• Medications: There are various medications available that can help manage inflammation:

1. 5-ASAs" are effective in reducing inflammation in the lining of the GI tract, particularly in the colon. They can be used to treat an ulcerative colitis flare or as a maintenance therapy to prevent the recurrence of the disease.

2. Steroids can suppress the immune system and are used to treat ulcerative colitis. Nonetheless, as a result of their adverse reactions, they are usually not employed for prolonged durations. For severe cases, medications that target the immune system may be necessary. These drugs include:

3. Adalimumab

4. Adalimumab-adbm- a biosimilar to Humira.

5. Adalimumab-atto - a biosimilar to Humira.

6. Azathioprine.

7. Certolizumab pegol.

8. Cyclosporine.

9. Golimumab.

10. Infliximab.

11. Infliximab-abda- a biosimilar to Remicade.

Nearly 90 percent of cases of ulcerative colitis go into remission with treatments for mild symptoms. However, if a person has "refractory" UC, they may require continuous steroid treatment. In contrast, complete remission with Crohn's disease is less common. Surgery may be necessary for some people, including up to 45 percent of people with ulcerative colitis and three-quarters of people with Crohn's. The doctor may recommend surgery if a person has severe symptoms that do not improve with medication, experiences a blockage in their digestive tract, or develops a tear or hole in the intestine.

Conclusion

In conclusion, ulcerative colitis and Crohn's disease are two types of inflammatory bowel diseases that share similar symptoms but differ in location, continuous inflammation, and layers affected. Since the location of inflammation is the primary factor that distinguishes between the two, doctors may need to perform internal examinations to diagnose the condition accurately. Treatment for both conditions involves making lifestyle changes, such as adjusting the diet, engaging in regular physical activity, avoiding stress triggers, and quitting smoking. Medications such as anti-inflammatory drugs, immunosuppressants, and biological therapies may also be prescribed to manage the symptoms and prevent complications. It is essential to work closely with a healthcare professional to manage these chronic conditions and prevent long-term complications.