Crohn Disease Differential Diagnoses
- Author: Priya Rangasamy, MD; Chief Editor: Julian Katz, MD more...
Diagnostic Considerations
Patients with ulcerative colitis frequently have bloody diarrhea, occasionally with tenesmus. Patients with Crohn disease frequently have abdominal pain and diarrhea, and occasionally they have symptoms of intestinal obstruction. A variety of intestinal and extraintestinal manifestations also may be observed in conjunction with either Crohn disease or ulcerative colitis. Despite extensive workup, 10% of patients with isolated Crohn colitis have an indeterminate colitis, with features of both Crohn disease and ulcerative colitis. If these patients undergo long-term follow-up, small bowel disease characteristic of Crohn disease ultimately develops.
Table. Characteristics Differentiating Crohn Disease and Ulcerative Colitis (Open Table in a new window)
| Characteristic | ||
| Crohn disease | Ulcerative colitis | |
| Distribution | Entire GI tract | Colon only, although gastritis recognized |
| Skip lesions | Continuous involvement proximally from rectum | |
| Pathology | Full thickness | Mucosa only |
| Granulomas (30%) | No granulomas | |
| Radiology | Entire GI tract | Colon only |
| Skip lesions | Continuous involvement proximally from rectum | |
| Fistulae, abscesses, fibrotic strictures | Mucosal disease only | |
| Cancer risk | Increased | Estimated 1% per year starting 10 years after diagnosis |
| Presentation | ||
| Crohn disease | Ulcerative colitis | |
| Bleeding | Occasional | Very common |
| Obstruction | Common | Uncommon |
| Fistula | Common | None |
| Weight loss | Common | Uncommon |
| Perianal disease | Common | Rare |
Differential Diagnoses
- Amebiasis
- Appendicitis, Acute
- Behcet Disease
- Carcinoid Tumor, Intestinal
- Celiac Disease and HLA-DQ2/DQ8
- Diverticulitis
- Gastroenteritis, Bacterial
- Gastroenteritis, Viral
- Giardiasis
- Irritable Bowel Syndrome
- Ulcerative Colitis
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| Characteristic | ||
| Crohn disease | Ulcerative colitis | |
| Distribution | Entire GI tract | Colon only, although gastritis recognized |
| Skip lesions | Continuous involvement proximally from rectum | |
| Pathology | Full thickness | Mucosa only |
| Granulomas (30%) | No granulomas | |
| Radiology | Entire GI tract | Colon only |
| Skip lesions | Continuous involvement proximally from rectum | |
| Fistulae, abscesses, fibrotic strictures | Mucosal disease only | |
| Cancer risk | Increased | Estimated 1% per year starting 10 years after diagnosis |
| Presentation | ||
| Crohn disease | Ulcerative colitis | |
| Bleeding | Occasional | Very common |
| Obstruction | Common | Uncommon |
| Fistula | Common | None |
| Weight loss | Common | Uncommon |
| Perianal disease | Common | Rare |

