Differentiate symptoms of Crohn’s and Ulcerative Colitis, key to improving patient remission rates

Both conditions affect the intestinal system, but have key aspects that differentiate them at the time of diagnosis.

Dr. Esther Torres, director of the Center for Inflammatory Bowel Diseases-UPR and president of the Esther A. Foundation. Photo: Journal of Medicine and Public Health. Fabiola Plaza.

The Dr. Esther TorresDirector of the Center for Inflammatory Bowel Diseases-UPR and president of the Esther A. Torres Foundation for Inflammatory Bowel Diseases (FEAT), indicated that although these conditions affect the digestive system, they do not share the same impact.

“They are not the same thing. Although Crohn’s and ulcerative colitis are the two main inflammatory bowel diseases, they are not the same because the Crohn’s disease it can affect any part of the intestinal tract, and ulcerative colitis only manifests itself in the large intestine in the colon,” explained the prominent doctor.

For that reason, the symptoms are different between both conditions, Torres indicated, who briefly explained that in the case of ulcerative colitis, they are ulcerative that form in the large intestine that cause bleeding, so it would be diarrhea with blood and among the symptoms Frequent diarrhea with blood and straining stands out.

In the Crohn’s diseasethere is persistent diarrhea, along with pain and weight loss. “That is why we always insist that Colitis must be given a last name, because colitis can have several reasons, and in this case it is important to make the proper diagnosis. In this case, case, colonoscopy is the best screening test.

There is a genetic component, ages vary between 15 and 35 years, and a second peak after 60 years with the condition is described, he said.

The medical literature refers to more differences, among which the following stand out:


The main differences between ulcerative colitis and colitis Crohn’s disease This is due to the different location of the lesions:

– The Crohn’s disease It can affect any section of the digestive tract, from the mouth to the anus. The colon and terminal ileum (last section of the small intestine) are the most frequent locations. In addition, the affectation is patchy: it can leave healthy areas between areas injured by inflammation.

– Ulcerative colitis does not affect the small intestine, only the colon. Inflammatory changes always begin in the rectum and affect the colon in an ascending fashion. Therefore, while in the Crohn’s disease the rectum of is sometimes affected, in ulcerative colitis it is always affected. The involvement is continuous, that is, there will be no patches of unaffected areas between inflamed areas.


As you well know if you have read the introductory article on the Crohn’s disease or ulcerative colitis, endoscopy is a fundamental test to make the diagnosis. This test not only allows you to directly see the intestinal mucosa and analyze its appearance, thanks to the small camera on its end, but also allows you to perform a biopsy of the most affected areas. In other words, it allows small tissue samples to be collected that will then be analyzed under a microscope.

Between Crohn’s disease and ulcerative colitis there are differences visible to the “naked eye” (macroscopic differences) and under the microscope (microscopic differences).

At the macroscopic level, in Crohn’s disease you can see:

– a cobbled mucosa, with deep ulcers, canker sores and transverse fissures.

– Stenosis and fistulae, in 75% of cases. This is because the inflammation affects all the layers of the intestinal wall, so that it is thickened in its entirety. This can cause areas where the caliber of the intestine decreases, called strictures, and pathways that connect the intestine with neighboring organs or the skin, called fistulas.

In contrast, ulcerative colitis does not produce fissures or fistulas, but it can show:

– a granular mucosal surface.

–superficial ulcers on occasions (being deep only in severe cases) and pseudopolyps.

– friability (with bleeding on rubbing).

At the microscopic level, the Crohn’s disease It can cause granulomas, that is, masses made up of cells of the immune system that group together as a “ball” to try to isolate foreign substances that the body does not recognize.

In contrast, ulcerative colitis can cause so-called crypt abscesses.


The symptoms are quite similar in the two diseases, although there may be some differences:

– In the Crohn’s disease abdominal pain is more common. In addition, it can be associated with a palpable mass in some cases and with symptoms of general malaise, weight loss, fever and another very frequent symptom is diarrhoea. Although this is different depending on the area of ​​the inflamed colon, it is usually larger than the diarrhea of ​​ulcerative colitis. On the other hand, the presence of fistulas and perianal disease (fistulas, fissures or anal abscesses) is frequent.

– In ulcerative colitis, the presence of blood and mucus in the stool (ie, proctorrhagia) is more frequent. Although diarrhea is also common, it is usually in the form of smaller and more numerous stools. In addition, there may be tenesmus (feeling of not having a bowel movement at all) and colic pain. General symptoms only occur in severe cases.

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