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Ulcerative Colitis Vs Crohn’s Disease Quiz

A Quiz to test your knowledge about Ulcerative Colitis vs Crohn’s Disease is presented at the end of the post.

You can find answers to your questions in the post below. It is therefore best to read the post first before answering the quiz.


Both Ulcerative Colitis and Crohn’s Disease are common in genetically predisposed individuals. Ulcerative Colitis is common in non-smokers while Crohn’s disease is common in smokers.

In addition, individuals who have had appendectomies are less likely to develop Ulcerative Colitis.

Ulcerative Colitis is more of a clinical diagnosis and confirmed by tissue biopsy. On the other hand, it is very difficult to diagnose Crohn’s disease based on its signs and symptoms.

 
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Ulcerative Colitis vs Crohn’s Disease:

Both Ulcerative Colitis and Crohn’s Disease are categorized as inflammatory bowel diseases. A person’s digestive system irritates often in both situations.

The immune system’s poor response to the microbiome that lives in a person’s stomach causes these inflammatory flare-ups.

The regions and ways that ulcerative colitis and Crohn’s disease affect a person’s intestines differ significantly from one another.


Site of Inflammation in Ulcerative Colitis vs Crohn’s Disease:

The colon is the only location ulcerative colitis may affect, in contrast to Crohn’s disease, which could also influence any tissue between the mouth and the anus.

In Crohn’s disease, patches of inflammatory tissue are scattered throughout the healthy intestine.

However, ulcerative colitis makes the colon permanently inflamed and can even invade the linings of the intestinal tissue.

 
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Signs and Symptoms of Ulcerative Colitis Vs. Crohn’s Disease:

Ulcerative colitis:

Some more common manifestations of ulcerative colitis include the following:

  • Fever
  • Malaise
  • Bloody diarrhea
  • Cramping rectal pain, or tenesmus
  • Mucus in stools
  • Unexplained weight loss
  • Needing to pass stools urgently

These signs usually get worse with time. Numerous individuals who suffer from ulcerative colitis also discover that their symptoms might temporarily improve before later getting worse.

Only 10% to 30% of those with ulcerative colitis experience other symptoms, which are less prevalent [Ref].

These signs, listed below, are extraintestinal, which means that the person’s intestines remain unaffected. They consist of:

  • Inflammation and joint issues
  • Thickening of a person’s subcutaneous fat layer
  • Axial arthropathies, or spine-related arthritis, and pyoderma gangrenosum, a rare inflammatory illness that results in skin ulcers,
  • Spine-related inflammatory disease called ankylosing spondylitis

Crohn’s Disease:

The signs and symptoms that are frequently found among patients of Crohn’s disease are listed below:

  • Diarrhea, which might come with blood and mucus, and stomach discomfort
  • Undiagnosed weight loss, bloating, gas, fever, and anemia
  • Having trouble absorbing nutrients from meals due to anorexia

In a manner similar to ulcerative colitis, the extraintestinal signs and symptoms of Crohn’s disease include:

  • Gallstones
  • Infected urinary tract
  • Infections and inflammations of the mouth and lips, as well as ocular stomatitis
  • Spondylitis and ankylosing
  • Fatty liver
 
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Diagnostic tests for Ulcerative Colitis vs Crohn’s Disease:

Ulcerative colitis:

A stool sample may be examined by a doctor to look for mucus or blood that could indicate ulcerative colitis. Doctors can rule out other problems, such as infections or germs, by using stool samples.

The colonoscopy, which involves inserting a tiny camera-equipped thin tube into the colon to see the whole interior and collect a sample of inflammatory tissue, is the gold standard for diagnosing Ulcerative Colitis.

Rectal involvement occurs at the start of the disease. Hence, it is unusual to find a normal rectum on colonoscopy in patients with Ulcerative Colitis.

In one study about 10% of the patients diagnosed with Ulcerative Colitis had normal rectum. It was noted that these patients are usually refractory to treatment [Ref].

Endoscopes are exclusively inserted through the anus while diagnosing ulcerative colitis. The two varieties are:

  • Sigmoidoscopy:
    • This procedure enables the medical professional to check the lower colon and rectum for the presence and severity of inflammation.
  • Total colonoscopy:
    • The doctor will look at the entire colon during this procedure.

Crohn’s disease:

The whole digestive system may become inflamed as a result of Crohn’s disease, and regions of both healthy and inflammatory tissue are frequently present.

The pathology report on the biopsied tissue can assist in making that diagnosis because Crohn’s disease may occasionally just affect the rectum and a portion of the colon.

Granulomas, which are immune cell clusters, are occasionally produced by Crohn’s disease but not by ulcerative colitis.

According to the Crohn’s and Colitis Foundation, granulomas are the consequence of your body’s effort to expel foreign matter, and the cells are discernible under a microscope.

The doctor may request that you undergo imaging tests, such as an MRI or CT scan, to get a closer look if they have evidence to assume that Crohn’s disease has impacted the small intestine.

Your doctor may do an upper endoscopy to identify the location of the inflammation of the esophagus or another portion of the upper GI tract is affected.

There are two different endoscopic procedures for Crohn’s disease:

  • Colonoscopy:
    • To examine the colon, a flexible tube called an endoscope is introduced via the anus.
  • Upper endoscopy:
    • Through the mouth, the pliable tube is inserted into the small intestine’s first section after passing through the stomach and esophagus.
 
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Radiographic Differences between Ulcerative Colitis and Crohn’s Disease:

There are subtle radiographic differences between Ulcerative Colitis and Crohn’s Disease which are presented in the table below:

Radiographic Differences

Ulcerative Colitis

Crohn’s Disease

Bowel InvolvedLarge Bowel

(Rectal Involvement in 95%)

Small Bowel: 70 – 80%

Large Bowel: 15 – 20%

DistributionContinuous Disease (Starts from the rectum and progresses proximally)Skip lesions (Area of bowel sparing is noted)
Fat Halo SignSeen in 61% of Chronic UCSeen in 8% of CD patients
Bowel WallThinThicker
Serosal SurfaceSmooth in 95%Irregular in 80%
Perianal InvolvementUncommonCommon (82%)

  • Stranding of peri-rectal fat (73%
  • Fistulas and Sinuses (22%)
Mesenteric Creeping FatNot seen (Small bowel not involved)Common in Chronic Cases
Abscess formationUncommonSeen in 15 – 20%

On Barium studies, Ulcerative Colitis is seen as a “Lead Pipe” because of loss of intestinal haustrations while strictures may be seen in Crohn’s Disease.

 
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Biopsy Differences between Ulcerative Colitis and Crohn’s Disease:

The biopsy is considered the Gold Standard test to diagnose IBDs. It can differentiate between Ulcerative Colitis and Crohn’s Disease.

Here are some differences in tissue biopsy:

Biopsy Findings

Ulcerative Colitis

Crohn’s Disease

Crypt abscessCommonScanty (Unusual)
Gut InvolvementContagious and superficialPatchy and Transmural
Goblet CellsDepletedNormal
GlandsLost (Atrophic)Preserved
Lymphocyte InfiltrationCommonPatchy
Muscularis mucosaThickenedNormal
Submucosal inflammationLittleHeavy
GranulomasAbsentPresent
 
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Complications of Ulcerative Colitis and Crohn’s Disease:

Ulcerative Colitis is associated with more frequent flare-ups and severe colitis that necessitates frequent hospitalization.

Crohn’s Disease, on the other hand, is a slowly progressing disease that presents a diagnostic dilemma.

The complications of Ulcerative Colitis and Crohn’s Disease are tabulated below:

Complications of IBDs

Ulcerative Colitis

Crohn’s Disease

GI bleedingMore common and severeLess often
ArthritisCommonUncommon
GallStonesUncommonCommon (30 – 50%)
Primary Sclerosing CholangitisCommonUncommon
Liver AbscessUncommonMay occur
PancreatitisUncommonCommon
CachexiaUncommonCommon
Toxic megacolonMore commonLess common
StricturesUncommonMore Common

Arthritis in patients with IBDs is referred to as Enteropathic arthritis. It is common in patients with Ulcerative Colitis compared to Crohn’s disease.

Axial involvement is common in enteropathic arthritis. Ankylosing spondylitis and peripheral arthritis can both affect these patients.

However, it has been observed that in patients with flare-ups of ulcerative colitis, peripheral arthritis is more common.

Hence, peripheral arthritis may be associated with disease flare-ups compared to axial involvement or ankylosing spondylitis.

 
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Which is Worse? Ulcerative Colitis Or Crohn’s Disease?

While both Crohn’s disease and ulcerative colitis are persistent disorders related to inflammation that impact the digestive tract, ulcerative colitis (UC) may be deemed to be “worse” due to the possibility that surgery may be necessary sooner and, in some cases, more urgently in cases of severe and extensive ulcerative colitis.

In rare cases, deep colonic ulcerations can cause uncontrollable bleeding when abrupt, acute ulcerative colitis is present.

Medications and injectable steroids are unable to treat the symptoms. A potentially fatal consequence brought on by extreme inflammation and requiring emergency surgery is toxic megacolon, which can develop as a result of severe, abrupt ulcerative colitis.

The signs and symptoms include excruciating pain, abdominal distension or bloating, fever, a fast heartbeat, constipation, and dehydration.

Are You Ready to Take the Ulcerative Colitis Vs Crohn’s Disease Quiz Now?

  • Question of

    Both Ulcerative Colitis and Crohn’s Disease are IBDs (Inflammatory Bowel Diseases)?

    • True
    • False
  • Question of

    IBDs are more common in females?

    • True
    • False
  • Question of

    Ulcerative Colitis affects the whole GI tract?

    • True
    • False
  • Question of

    Rectum is rarely involved in Ulcerative Colitis?

    • True
    • False
  • Question of

    Skip Lesions are found in Crohn’s disease?

    • True
    • False
  • Question of

    Abscess and Sinuses occur commonly in Crohn’s disease compared to Ulcerative Colitis?

    • True
    • False
  • Question of

    Crypt Abscesses are seen in Ulcerative Colitis

    • True
    • False
  • Question of

    Transmural involvement is a feature of Crohn’s Disease?

    • True
    • False
  • Question of

    Granulomas can be seen commonly in Crohn’s Disease?

    • True
    • False
  • Question of

    GI bleeding is more severe in Ulcerative Colitis?

    • True
    • False
  • Question of

    Primary Sclerosing Cholangitis is more commonly seen in Ulcerative Colitis

    • True
    • False
  • Question of

    Toxic Megacolon is common in Crohn’s Disease compared to Ulcerative Colitis?

    • True
    • False

What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

Here is a link to My Facebook Page. You can also contact me by email at contact@dibesity.com or at My Twitter Account
You can also contact me via WhatsApp 🙏

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