Learn the important differences between Ulcerative Colitis vs Crohn’s Disease. While both U.C. and Crohn’s are types of Inflammatory Bowel Diseases (IBD), they do have some important differences to know.

If you have recently been diagnosed with Ulcerative Colitis or Crohn’s Disease, or are suspecting you might be suffering with one of these conditions, this video / article will help you understand the similarities and differences between Ulcerative Colitis vs Crohn’s Disease.

As a bonus, you’ll learn one important tip regarding Ulcerative Colitis vs Crohn’s treatment.

Table of Contents

Video:

Stream this Podcast episode:

Summary:

  • Learn the similarities and differences between Ulcerative Colitis vs Crohn’s Disease.
  • Learn how Ulcerative Colitis and Crohn’s are diagnosed.
  • Understand 1 reason to be cautious about a particular type of treatment.

Main Article:

In this article, we are going to be discussing some of the major differences as well as similarities between Ulcerative Colitis vs Crohn’s Disease.

If you have recently been diagnosed with either Ulcerative Colitis or Crohn’s, or you are considering that you might be suffering from Inflammatory Bowel Disease (IBD), in which Ulcerative Colitis and Crohn’s are the top 2 “types” of IBD, then this video will help you get clear on what sets them apart and how they overlap.

I’m also going to be giving you one important tip when it comes to treatment for Ulcerative Colitis vs Crohn’s Disease.

Autoimmune Conditions / Chronic Inflammation

The first similarity for both U.C. and Crohn’s is that they are both considered to be autoimmune conditions at their core.

This means that the immune system isn’t functioning like it should. The body starts to improperly attack itself as if it is a foreign invader (like bacteria, a virus, or fungus).

This is what sets up and continues to cause chronic inflammation.

This is also why traditional anti-inflammatory treatments are not very effective long term. While you may be able to suppress the inflammation somewhat, you are not targeting the cause of the inflammation (the dysfunctional immune system) and thus the inflammation will continue to be produced.

While there are many different contributors / risk factors that can set the stage for the immune system to start the immune system from functioning improperly – such as genetics, diet [1], and chronic stress [2, 3] – there is no one trigger that is agreed upon to be THE cause.

Not “Overactive” Immune System – Dysregulated Immune System

It is important to point out that it isn’t really true that the entire immune system is “overactive” with Ulcerative Colitis or Crohn’s.

In fact, there are certain parts of the immune system, such as T-regulatory cells (a type of white blood cell), that are essentially always decreased in Ulcerative Colitis or Crohn’s.[4] This is important to know, because T-regulatory cells actually help protect our body from attacking itself.[4] Thus, decreased T-regulatory cell count actually increases autoimmunity (and thus chronic inflammation).[5]

Therefore, it is better to think in terms of immune system “dysregulation” instead of having an “overactive” immune system.

Besides T-regulatory cells, there are various other immune cells and cytokines that are either upregulated or downregulated in Crohn’s or U.C.[5]

Suppressing Entire Immune System Doesn’t Work Long Term

If we are locked into this idea that what we need to do is suppress the “overactive” immune system, then we might buy into the idea that repeated cortisone-like steroids is a good way to treat Ulcerative Colitis or Crohn’s.

However, many research papers have showed that this isn’t necessarily a good idea. While sometimes steroids can be effective short-term, when they are relied on long-term, they can create more problems than they solve.

For example, for Ulcerative Colitis, one paper states:

Steroids may be temporarily effective, but subsequently may make patients steroid-dependent, resulting in long-term treatment and increased risks of adverse drug reactions. Therefore, it is important to withdraw steroids as early as possible in treatment of UC.

Okayasu et. al. 2019

Similarly, for Crohn’s Disease, another paper states:

“Corticosteroids are highly effective in inducing clinical remission in patients with active Crohn’s disease. However, the role of corticosteroids in the treatment of this disease is primarily ameliorative because they are ineffective in maintaining remission or healing mucosal lesions. Nearly half of the patients who initially respond to corticosteroid therapy develop a dependency on corticosteroids or have a relapse within 1 year.”

Rutgeerts et. al. 2001

Understanding Inflammation and Healing

These results are easy to understand if you understand how the immune system works.

When you use steroids to suppress the immune system, you do temporarily decrease inflammation, but you also stop healing.

This is the same mechanism of how chronic stress (i.e. chronically high cortisol / stress hormones) can promote stomach ulcers.

The stomach lining is one of the tissues that need the most continuous repair. In fact, we get a new stomach lining approximately every 7 days or so. Therefore, if you are chronically stressed, and thus have chronically high cortisol, then healing and repair will be suppressed. For those without Crohn’s or U.C., the effect of this can show up first in the stomach as an ulcer.

For those with IBD, it can show up instead as a worsening / non-healing of their colon damage.

Again, this doesn’t mean that steroids should never be used.

It simply means they should not be relied upon long-term.

Ulcerative Colitis vs Crohn’s Disease: Different Types of Colon Damage

An important difference between Ulcerative Colitis vs Crohn’s Disease is the “type” of damage that gets produced and shows up during a colonoscopy.

In Crohn’s Disease, the doctor will observe something called “skip lesions”.

This is when there is damaged colon tissue, separated by healthy tissue, separated again by damaged tissue. Thus, the damaged regions “skip” around and are not continuous.

In contrast, for Ulcerative Colitis, the damage is more continuous throughout the colon. Skip lesions are not observed.

Ulcerative Colitis vs Crohn’s Disease: Different Layers and Areas of Damage

Entire GI Tract vs Colon Only

Besides the skip lesions, Crohn’s Disease can also affect more aspects of the gastrointestinal tract than just the colon.

For Crohn’s, the damage can actually appear anywhere from the rectum all the way to the mouth and lips. It can involve the entire GI tract. This is why sometimes those suffering from Crohn’s can develop mouth sores, for example.

This is in contrast to Ulcerative Colitis in which the damage is almost always contained to just the colon itself.

All Colon Layers vs Inner Layer Only

One last difference between Ulcerative Colitis vs Crohn’s Disease is that Crohn’s disease usually affects all the colon tissue layers.

For Ulcerative Colitis, usually only the inner layer of the colon tissue is affected.

Conclusion: Ulcerative Colitis vs Crohn’s Disease

Differences between Ulcerative Colitis vs Crohn's Disease
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I hope this helps you with your ongoing IBD journey!

Now you know about some of the major differences as well as similarities for Ulcerative Colitis vs Crohn’s Disease.

In an upcoming article, I am going to go over the differences and similarities in symptoms for Ulcerative Colitis vs Crohn’s Disease, so stay tuned for that; and if you haven’t subscribed yet to get updates, scroll up and click the subscribe button under the video above!

FREE GIFT

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Warmly,

Dr. Sean

References:

  1. Andersen V, Olsen A, Carbonnel F, Tjønneland A, Vogel U. Diet and risk of inflammatory bowel disease. Dig Liver Dis. 2012 Mar;44(3):185-94. doi: 10.1016/j.dld.2011.10.001. Epub 2011 Nov 3. PMID: 22055893.
  2. Sun Y, Li L, Xie R, Wang B, Jiang K, Cao H. Stress Triggers Flare of Inflammatory Bowel Disease in Children and Adults. Front Pediatr. 2019;7:432. Published 2019 Oct 24. doi:10.3389/fped.2019.00432
  3. Gao X, Cao Q, Cheng Y, Zhao D, Wang Z, Yang H, Wu Q, You L, Wang Y, Lin Y, Li X, Wang Y, Bian JS, Sun D, Kong L, Birnbaumer L, Yang Y. Chronic stress promotes colitis by disturbing the gut microbiota and triggering immune system response. Proc Natl Acad Sci U S A. 2018 Mar 27;115(13):E2960-E2969. doi: 10.1073/pnas.1720696115. Epub 2018 Mar 12. Erratum in: Proc Natl Acad Sci U S A. 2018 Apr 30;: PMID: 29531080; PMCID: PMC5879702.
  4. Pedros C, Duguet F, Saoudi A, Chabod M. Disrupted regulatory T cell homeostasis in inflammatory bowel diseases. World J Gastroenterol. 2016;22(3):974-995. doi:10.3748/wjg.v22.i3.974
  5. Yamada A, Arakaki R, Saito M, Tsunematsu T, Kudo Y, Ishimaru N. Role of regulatory T cell in the pathogenesis of inflammatory bowel disease. World J Gastroenterol. 2016;22(7):2195-2205. doi:10.3748/wjg.v22.i7.2195
  6. Okayasu M, Ogata H, Yoshiyama Y. Use of corticosteroids for remission induction therapy in patients with new-onset ulcerative colitis in real-world settings. J Mark Access Health Policy. 2019;7(1):1565889. Published 2019 Jan 22. doi:10.1080/20016689.2019.1565889
  7. Rutgeerts PJ. Review article: the limitations of corticosteroid therapy in Crohn’s disease. Aliment Pharmacol Ther. 2001 Oct;15(10):1515-25. doi: 10.1046/j.1365-2036.2001.01060.x. PMID: 11563990.

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