Crohn Disease vs Ulcerative Colitis
Crohn Disease and Ulcerative Colitis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Crohn Disease vs Ulcerative Colitis at a glance
- Crohn Disease: Chronic transmural inflammation that can involve any segment of the GI tract; skip lesions and fistulizing disease.
- Ulcerative Colitis: Chronic mucosal inflammation beginning at the rectum and extending proximally in a continuous pattern.
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Side-by-side comparison
| Feature | Crohn Disease | Ulcerative Colitis |
|---|---|---|
| At a glance | Chronic transmural inflammation that can involve any segment of the GI tract; skip lesions and fistulizing disease. | Chronic mucosal inflammation beginning at the rectum and extending proximally in a continuous pattern. |
| Classic presentation | Young adult with months of crampy RLQ pain, intermittent diarrhea, weight loss, and perianal fistula or abscess.; Chronic diarrhea (often non-bloody but can… | Young adult with weeks of bloody diarrhea, tenesmus, and urgency; LLQ tenderness; flexible sigmoidoscopy reveals continuous mucosal inflammation starting at… |
| Workup / key labs | Composite of clinical, endoscopic, radiologic, and histologic features. Hallmarks: discontinuous inflammation, skip lesions, transmural disease, terminal… | Composite of clinical (bloody diarrhea, urgency), endoscopic (continuous mucosal erythema, friability, ulceration starting at rectum), and histologic (crypt… |
| Imaging | Ileocolonoscopy with biopsy of terminal ileum and each colonic segment — establishes diagnosis; aphthous → linear/serpiginous ulcers, cobblestoning, skip… | Flexible sigmoidoscopy at initial presentation (often sufficient for diagnosis in mild disease and avoids perforation risk in severe disease); Full… |
| First-line treatment | Smoking cessation — single most impactful intervention; Nutritional optimization; supplement iron, B12, vitamin D; Induction: corticosteroids (prednisone,… | Disease extent and severity determine therapy; Mild-moderate proctitis or distal disease: topical 5-ASA — mesalamine suppository or enema; can add oral 5-ASA;… |
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