What is Inflammatory Bowel Disease?

By Rebecca McKinsey

Breaking Down the Differences—and Similarities—between Crohn’s Disease and Ulcerative Colitis 

The inflammatory bowel disease (IBD) umbrella covers two major digestive immune-mediated diseases—with overlapping symptoms but potentially different root causes, complications, and treatments.

Crohn’s disease and ulcerative colitis (also called UC or colitis) are the two main types of IBD. Crohn’s causes inflammation anywhere in the gastrointestinal tract, from the mouth to the anus, while colitis is confined to the large intestine, or colon.

Similarities and differences

Crohn’s and ulcerative colitis carry similar symptoms: stomach pain, diarrhea, rectal bleeding, urgency to defecate, weight loss, and fatigue. Crohn’s disease can also cause fistulas (tracts between the intestines to other parts of the body such as the skin, another portion of the intestines, or the bladder or vagina) or strictures (narrowing of the bowel).

Symptoms vary and can be mild to severe, says Bincy Abraham, MD, a gastroenterologist at Houston Methodist Hospital and Fondren distinguished professor in inflammatory bowel disease at the Houston Methodist Academic Institute. A diagnosis is reached by finding inflammation in the gastrointestinal tract or colon with a colonoscopy or other test, with the location of the inflammation determining the type of IBD.

Many medications are approved to treat both conditions. Crohn’s and ulcerative colitis may require the use of biologics, which target specific areas of the immune system. Treatment for ulcerative colitis can also include 5-aminosalicylates as well as small molecules.

Susan Blum, MD, a leading functional doctor and the founder and director of the Blum Center for Health in New York, works with people with IBD in tandem with their gastroenterologists to treat their conditions holistically. For colitis, Blum says, high-dose probiotics can ease symptoms. She works with patients with both types of IBD to treat the microbiome and reduce inflammation and irritation in the gut with herbs, supplements, fish oil, vitamin D, and turmeric.

Some cases of IBD require surgery. A colectomy, the removal of the colon, can treat patients with severe refractory colitis. Crohn’s patients sometimes need surgical removal of strictured areas of the intestine or fistula repair.

“We have to take care of the patient systemically,” Abraham says. “GI diseases can affect the joints and cause anxiety or other chronic diseases. And both (Crohn’s and colitis) don’t have a cure. It’s a chronic inflammatory disease they’ll have for the rest of their life. They need a multidisciplinary approach.”

Finding support

Abraham urges those with IBD to find a community of people who understand and can help.

The Crohn’s and Colitis Foundation offers a variety of resources, as does Color of Crohn’s and Chronic Illness (COCCI), which was formed to support BIPOC with digestive disorders.

“We have over three million Americans living with this disease,” Abraham says. “There’s a lot of support for them—they just need to seek it. They shouldn’t be facing this alone.”    •

Beyond Crohn’s and colitis

In some cases, symptoms similar to Crohn’s and colitis that cannot be linked to the immune system and do not involve inflammation are diagnosed as irritable bowel syndrome (IBS), often called a diagnosis of exclusion.

Another autoimmune disease, Celiac disease, is not classified as an inflammatory bowel disease, although it has many of the same symptoms. In this disease, an immune system attack on the small intestine is triggered by eating gluten, which is found in grains such as wheat, rye, or barley. Symptoms typically are drastically reduced by eating a gluten-free diet.