Crohn’s disease and ulcerative colitis (UC) are both forms of inflammatory bowel disease (IBD). A patient can have Crohn’s disease, UC, or both types. There is no cure for either, however, symptoms can usually be arrested with proper management through medication and lifestyle. Less often,IBD turns to surgery for management. For example, around 30 percent of patients with ulcerative colitis will ultimately need surgery.
Both forms of IBD affect men and women the same, they both involve severe inflammation of the digestive tract, and the symptoms for Crohn’s disease and UC are almost identical. However, a few differences set these two apart from each other.
Crohn’s disease can affect the entire digestive tract, from the mouth to the anus. Instead of continuous inflammation, Crohn’s often appears in patches, in between healthy tissue. Crohn’s disease can also penetrate all the layers of the bowel wall.
Ulcerative colitis only appears in the large intestine (colon) and rectum. Instead of appearing in patchy spots, colon inflammation from UC is continuous, always involving the rectum and often other parts of the colon. Ulcerative colitis also only inflames the innermost part of the colon, as opposed to all layers in Crohn’s disease.
Crohn’s disease can often be managed through medication and diet. However, just under half of those with Crohn’s disease will have at least one related surgery in their lifetime. There are several different types of medications used to manage Crohn’s disease symptoms:
Beyond medications, there are other ways to manage Crohn’s disease. Your provider may recommend a special diet (along with medication) to treat the disease and improve overall nutrition. A feeding tube (enteral nutrition) or nutrients delivered intravenously (parenteral nutrition) are both types of nutrition therapy used widely to manage Crohn’s disease.
The last type of Crohn’s management is surgery. A surgeon removes a damaged portion of the GI tract during a surgical procedure and replaces it with healthy tissue. This can cause remission, but inflammation due to Crohn’s disease flare-ups often returns after surgery.
There are some preventative measures you can take to avoid Crohn’s flare-ups. Be sure to let your doctor know at the first sign of a flare-up so they can examine you. To help prevent flare-ups:
Dietary changes that are often suggested include reducing consumption of greasy and fatty foods, eliminating dairy, avoiding gas-producing foods such as beans, and eating only well-cooked vegetables.
Even though it is a different condition, the medical management of UC is roughly the same as that of Crohn’s disease: anti-inflammatory drugs, immunosuppressors, and biologics. Oral 5-aminosalicylates such as mesalamine is typically used as a first line agents for mild-moderate ulcerative colitis. Your doctor may also recommend Janus kinase (JAK) inhibitors, which interact with enzymes to limit inflammation. The same diet and adherence to lifestyle changes (such as quitting smoking) are also recommended for UC management.
Systemic corticosteroids are not recommended as UC maintenance post-remission. However, continuing with anti-TNF therapy, vedolizumab, and/or tofacitinib is recommended, according to the American College of Gastroenterology.
Surgery is an option when patients do not respond to medication and lifestyle changes. The two main types of surgeries used to treat ulcerative colitis are proctocolectomy and ileoanal pouch (J-pouch surgery) and proctocolectomy and ileostomy.
Just as with Crohn’s disease, let your doctor know right away if you feel a flare-up coming on. Advice for management and preventative measures for UC are very much the same—quit smoking, limit alcohol, do not take NSAIDs, and avoid spicy foods. However, you can also manage potential flare-ups by eating smaller meals (every two to four hours) and by keeping a food diary, so you can keep track of what foods may trigger either Crohn’s disease or ulcerative colitis symptoms.
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