Crohn Disease Differential Diagnoses

Updated: Jan 06, 2017
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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DDx

Diagnostic Considerations

Patients with Crohn disease frequently present with abdominal pain, nonbloody diarrhea, weight loss, fever, and, sometimes, obstructive symptoms such as nausea, early satiety, and vomiting. A variety of intestinal manifestations and extraintestinal manifestations (EIMs) also may be observed in conjunction with either Crohn disease or ulcerative colitis. Features differentiating the 2 forms of inflammatory bowel disease (IBD) are summarized in Table 1, below.

Table 1. Characteristics Differentiating Crohn Disease and Ulcerative Colitis (Open Table in a new window)

Characteristic

 

Crohn Disease

Ulcerative Colitis

Distribution

Entire gastrointestinal tract

Colon only, though gastritis is recognized

Skip lesions

Continuous involvement proximally from rectum

Pathology

Full thickness

Mucosa only

Granulomas (15-30% in biopsy specimens; 40-60% in surgically resected bowel)

No granulomas

Radiology

Entire gastrointestinal tract

Colon only

Skip lesions

Continuous involvement proximally from rectum

Fistulae, abscesses, fibrotic strictures

Mucosal disease only

Cancer risk

Increased

Estimated to be 3% at 10 years, 8% at 30 years, and 18% at 30 years after diagnosis [46] ; risk is higher in patients with primary sclerosing cholangitis and long-standing colitis (> 8-10 y); may be lower in subsequent studies (see Intestinal Manifestations).

Presentation

 

Crohn Disease

Ulcerative Colitis

Bleeding

Occasional

Very common

Obstruction

Common

Uncommon

Fistulae

Common

None

Weight loss

Common

Uncommon

Perianal disease

Common

Rare

Despite extensive workup, 15% of patients with isolated colitis have an undetermined type of IBD that shows features of both Crohn disease and ulcerative colitis. The distinction is often difficult to make, especially if the patient meets all diagnostic criteria for ulcerative colitis but is a smoker or has rectal sparing—features that suggest the possibility of Crohn disease or IBD of undetermined type.

In addition, there is a subpopulation of patients with Crohn colitis who will not develop small bowel disease in their lifetime. This group represents approximately 20% of the colitis patients.

Differential Diagnoses