Understanding Crohn’s Disease and Ulcerative Colitis Q&A with Dr. Bhavesh Patel, MD, Gastroenterologist

The first week of December marks Crohn’s and Colitis Awareness Week, which focuses on two main types of Irritable Bowel Disease (IBD), Crohn’s disease and ulcerative colitis (UC).

Crohn's disease and UC are two of the most common forms of IBD. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), there are an estimated 1 million people in the United States living with Crohn’s disease, and about 600,000 to 900,000 people in the United States with UC.

Crohn’s disease can affect any part of the digestive tract from the mouth to the end of the digestive tract. The inflammation it causes may extend through the entire thickness of the intestinal wall, a pattern known as transmural inflammation. It often develops in scattered segments, creating healthy areas between inflamed sections. These are commonly referred to as skip areas.

Ulcerative colitis affects only the colon and rectum. Unlike Crohn’s, inflammation caused by UC is confined to the inner lining of the bowel, called the mucosal layer. UC typically begins in the rectum and then spreads upward in a continuous pattern through part or all of the colon.

We asked Bhavesh Patel, MD, gastroenterologist, about some common myths, misconceptions and questions regarding Crohn’s disease, UC and IBD in general.

1. "Crohn’s disease and ulcerative colitis are the same as Irritable Bowel Syndrome (IBS).”

As a gastroenterologist caring for around 200 patients with Crohn's disease or UC, this is one of the most common myths my patients ask me about. It is essential to understand the difference because Crohn’s disease and UC are very different from IBS.

IBS affects bowel function and is a functional gastrointestinal disorder, meaning there is a problem with how the gut works, not with visible damage or inflammation of the intestines.

Crohn’s disease and UC both involve visible inflammation and damage to the digestive tract. These require different evaluations and treatments.

2. "Crohn’s disease and UC are caused by spicy foods and excessive stress."

Stress and diet can exacerbate symptoms, but are not the cause. The exact cause of them are unknown but it is believed that Crohn’s disease and UC stem from n abnormal immune response, possibly influenced by genetics, environment and gut bacteria.

3. "If my family member has Crohn’s disease or UC, I will as well."

Having a family member with Crohn’s or UC does not automatically mean you will develop it as well. Genetics do play a role in whether or not you will develop UC or Crohn’s disease, with about 20% of people who develop either having a close family relative with UC or Crohn’s. Still, it is not the only cause, and other factors are also in play like environmental (diet, smoking, early life factors, medications and gut microbiome) and immune system factors (abnormal immune response, chronic inflammation and infection).

4. “There’s nothing you can do to resolve symptoms— you just have to live with it.”

Out of all the misconceptions I hear, this one is definitely false. With modern medications, dietary changes, and lifestyle management, most patients can and do lead full lives with Crohn’s or UC. In the past 20 years alone, there have been major advances in medications to manage these conditions and reduce the need for surgery. This is all thanks to modern medicines, including biologic and targeted therapies.

5. “Ulcerative Colitis is the only type of colitis.”

This is false. The term colitis simply means inflammation of the colon. Ulcerative colitis is one type, but there are other forms, including infectious colitis, ischemic colitis, microscopic colitis and drug-induced colitis. While Crohn’s disease can also affect the colon, it is a broader condition because it can involve any part of the digestive tract and affects the full thickness of the intestinal wall, not just the lining.

6. “Surgery cures Crohn’s disease.”

Surgery can remove damaged sections of the intestine or treat complications, but Crohn’s disease can recur in other areas. UC, on the other hand, can be “cured” by colon removal; however, this is needed in only a small number of patients who do not benefit from other interventions.

7. “Crohn’s disease and UC are preventable.”

You cannot prevent Crohn’s disease or UC, but you can manage symptoms and reduce flare-ups by adopting several lifestyle and dietary changes.

Ease Symptoms and Reduce Flare-Ups in Crohn's Disease or UC:

• Stop smoking – smoking can increase flare-ups in people with Crohn’s disease
• Avoid medications that can trigger flare-ups, like some types of nonsteroidal anti-inflammatory drugs (NSAIDS). Common NSAIDS include Motrin® and Advil®. Ask your healthcare provider what medicines to avoid if you have Crohn’s disease or UC.
• Avoid foods and beverages that can trigger a flare-up for you. This can look different for each person, so it’s essential to discuss with your provider and keep a food diary to catalog foods that worsen your symptoms.
• Care for your mental and physical health – getting enough sleep and exercise, and caring for your overall health, is important when trying to manage stress.

Diagnosis and Symptoms

Crohn’s disease and UC are diagnosed through a combination of endoscopy, imaging, blood tests, and lab tests that evaluate inflammation and rule out infection. If you suspect you may have Crohn’s disease or UC, below are symptoms to watch for and discuss with your primary care physician or GI.

If you suspect you may have Crohn’s disease, UC, or another type of IBD, or would like to discuss your options, contact your primary care physician or gastroenterologist. If you don’t have a primary care provider, visit mypvhc.com to find one near you.

Symptoms of Crohn’s Disease and Ulcerative Colitis (UC):

Crohn’s disease and UC share many symptoms because both involve chronic inflammation of the digestive tract.

Common Symptoms (Both Conditions):

• Persistent diarrhea (sometimes with blood or mucus)
• Blood in the stool
• Belly pain or cramping
• Urgency to use the bathroom or a feeling of incomplete evacuation
• Fatigue or fever
• Reduced appetite and weight loss

Some patients may also experience joint pain, skin rashes, or eye inflammation.

More Common in Crohn’s Disease:

• Nausea or vomiting
• Mouth sores
• Pain or drainage near the rectal area due to fistulas or abscesses

More Common in Ulcerative Colitis:

• Diarrhea with blood or mucus
• Rectal pain or bleeding
• Feeling urgency but being unable to pass stool (tenesmus)

When to See a Doctor:

• Blood in the stool
• Diarrhea lasting more than 1–2 weeks
• Ongoing belly pain
• Persistent nausea or vomiting
• Unexplained weight loss
• Fever with digestive symptoms

If you suspect you may have Crohn’s disease, UC, or another type of IBD, or would like to discuss your options, contact your primary care physician or gastroenterologist. If you don’t have a primary care provider, visit mypvhc.com to find one near you.