Crohn's Disease and Ulcerative Colitis: Symptoms and Tests

What it involves

MedlinePlus describes Crohn's disease and ulcerative colitis as the two main types of inflammatory bowel disease, or IBD, which cause long-lasting inflammation of the digestive tract. Crohn's can affect any part from the mouth to the anus, usually the small intestine and the start of the large intestine, while ulcerative colitis inflames the lining of the colon and rectum.

Who this is for

• Adults with diarrhea, belly cramping or weight loss that has lasted more than a few weeks without a clear cause
• Patients who notice blood or pus in the stool or the feeling of needing to go when the bowel is empty
• People with a parent, brother, sister or child who has inflammatory bowel disease
• Patients already diagnosed who want a primary care provider to coordinate blood work and preventive care

What to expect

• Questions about stool changes, belly pain, weight, fevers, joint pain, eye or skin problems and family history
• An exam of the abdomen for tenderness, and a check for signs such as mouth sores or swollen joints
• Blood work, which can include a blood count to look for anemia and markers of inflammation
• A referral to a gastroenterologist for colonoscopy or imaging when the picture points to IBD

How the two conditions differ

The MedlinePlus encyclopedia says ulcerative colitis begins in the rectal area, may stay there or spread through the large intestine, and does not skip areas. Crohn disease can involve any part of the digestive tract, most often the lower end of the small intestine and the start of the large intestine. The exact cause of each is unknown, both involve the immune system, and both can flare and then quiet down. The irritable bowel syndrome guide covers a different cause of similar symptoms.

Symptoms MedlinePlus lists

For Crohn's, the most common are diarrhea, cramping and pain in the abdomen and weight loss, along with fever, fatigue, loss of appetite, mouth ulcers, joint pain and eye redness. For ulcerative colitis, the most common are abdominal pain and blood or pus in diarrhea, with fever, weight loss and severe tiredness. The blood in stool guide and the unintentional weight loss guide explain how a provider approaches two of these signs on their own.

Problems outside the bowel

MedlinePlus says Crohn's disease can cause a blockage in the intestine, fistulas, which are abnormal connections inside the body, pus-filled abscesses, small tears around the anus, and malnutrition when the body does not absorb enough nutrients. Inflammation can also reach the joints, eyes and skin. Anemia is a listed symptom, which the anemia guide explains, and joint swelling is covered in the swollen joints guide.

How a provider reaches a diagnosis

MedlinePlus lists a medical and family history, a physical exam, blood and stool tests, and then colonoscopy, upper endoscopy, CT scan, MRI or an x-ray series with barium. For ulcerative colitis, a colonoscopy with a biopsy is most often used, and it is also used to screen for colon cancer, which the colorectal cancer screening guide describes. Serenity By A Dr. Sareen lists blood work among its services, and the complete blood count guide explains the test that checks for anemia.

Treatment goals

MedlinePlus says there is no cure for Crohn's disease, and that the goals of treating ulcerative colitis are to control attacks, prevent repeat attacks and help the colon heal. Medicines described include anti-inflammatory drugs, corticosteroids and drugs that quiet the immune system, and a severe episode can need a hospital stay. Surgery to remove the colon cures ulcerative colitis. The encyclopedia warns that aspirin, ibuprofen and naproxen can make colitis symptoms worse, so ask before using them. Specialty care is arranged by referral.

Eating and daily life

The encyclopedia suggests small amounts of food through the day, plenty of water, and avoiding high-fiber foods such as bran, beans, nuts, seeds and popcorn, as well as greasy or fried foods, during flares. Limiting dairy can help if you are lactose intolerant, as the lactose intolerance guide explains. Stress and certain foods do not cause the disease but can make symptoms worse. Ask your provider whether you need extra iron, calcium, vitamin D or vitamin B12. Back and hip stiffness is more common in people with bowel inflammation, and the ankylosing spondylitis guide explains why.

Sources

• MedlinePlus: Crohn's Disease (health topic)
• MedlinePlus: Ulcerative Colitis (health topic)
• MedlinePlus: Crohn disease (medical encyclopedia)
• MedlinePlus: Ulcerative colitis (medical encyclopedia)