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Ulcerative colitis and Crohn's disease are the two main forms of inflammatory bowel diseases. Celiac disease is a disease in which the small intestine is hypersensitive to gluten, leading to difficulty in digesting food. All of these conditions are characterized by inflammation of the digestive tract.  Although they share many similarities, there are key differences between the three diseases. We’ll review those differences concerning symptoms, causes, treatment and prevalence.

Crohn’s Disease

Crohn’s disease is a chronic inflammatory condition that impacts the gastrointestinal tract, and can cause inflammation, ulcers and bleeding. It is one of a group of chronic diseases often called inflammatory bowel disease (IBD). What separates Crohn’s disease from other forms of IBD is that it most commonly affects the end of the small bowel and the beginning of the colon.

However, it can affect your body at any point of the GI tract, from mouth to anus. Physicians also note that inflammation related to Crohn’s disease can manifest in patches so that there are areas of diseased as well as unaffected parts of the intestine. It may extend through multiple layers of the intestinal wall.

The disease causes your immune system to attack healthy cells and produce inflammation. The cause of this is unknown, though doctors are currently looking into both genetic and environmental factors that may signal the body to begin an immune response, without a clear “stop” signal.

Currently, Crohn’s is more common in developed countries and may affect as many as 780,000 Americans, so diet is believed to play a role in its development. It occurs most commonly in ages 15 to 35, though researchers are beginning to find it in younger children as well. If a family member has Crohn’s disease, related children have an increased chance of developing it.

Crohn’s disease is commonly treated with dietary restrictions — such as avoiding dairy products, seasoning and high-fiber foods — medication designed to suppress the immune system and surgery. The Crohn's & Colitis Foundation notes that  70 percent of people with the disease eventually require surgery.

Common Symptoms of Crohn’s Disease:

• Abdominal cramping and pain
• Diarrhea
• Fatigue
• Fever
• Inflammation in the eyes
• Nausea
• Rectal bleeding and anemia
• Sores, commonly in the mouth, legs and anus
• Urgency in defecation and incontinence
• Weight loss

Ulcerative Colitis

Ulcerative colitis is a chronic disease of the large intestine, known as the colon, where the lining becomes inflamed and will usually develop ulcers and sores that produce pus. This ulceration and related inflammation can make the disease painful and lead to frequent trips to the bathroom.

Ulcerative colitis results from the body’s immune response acting incorrectly, targeting the bacteria, food and other materials in the lining of the colon. Their presence leads to chronic inflammation and ultimately causes ulcers.

Symptoms can come and go, with potentially long intervals between flare-ups when there might be little to no symptoms or side effects. The disease has been known to go into remission for up to years at a time, though it will often return. The unfortunate side to this is that the disease can be unpredictable, which makes it hard for doctors to diagnose and know if treatments are truly effective.

Ulcerative colitis only affects the innermost lining of the colon while Crohn's disease can occur in all layers of the bowel walls. Because the two conditions are the two chief forms of IBD, about 10 percent of cases will exhibit features of both.

The Crohn's & Colitis Foundation says that recent research it has sponsored may point to viral or bacterial infections in the colon as a genesis. When the body responds naturally to fight off the infection, inflammation occurs. However, inflammation and immune response may persist in patients long after the infection has cleared.

The disease may impact as many as 907,000 Americans and most people with the disease are diagnosed in their early- to mid-30s. There may be a genetic component to the disease, as those with family members who have it are slightly more likely to have it compared to the general population, but it is not well understood.

Treatments for ulcerative colitis typically include combinations of medication, therapy, dietary changes and surgery. Up to one-third of patients with ulcerative colitis may not find relief through medication or diet, and then undergo a colectomy to remove the colon.

Common Symptoms of Colitis:

• Bowel movements become loose and more urgent
• Persistent diarrhea
• Bloody stool
• Ongoing cramps
• Abdominal pain
• Loss of appetite and weight loss
• Fatigue
• Children may experience a delay in growth or development

Celiac Disease

Celiac disease is an autoimmune disease where the consumption of gluten causes damage and inflammation in the small intestines. It is characterized by a severe intolerance to gluten — a type of protein that is found in barley, rye and wheat.

For people with celiac disease, eating even a small amount of gluten can cause the immune system to target the small intestine and harm the inner lining. This damage is painful and can lead to long-term difficulties in absorbing nutrients from foods.

Presently there is no known cure for celiac disease. Doctors prescribe a gluten-free diet to relieve and eliminate symptoms. Unfortunately for many, gluten is commonly used in processed foods and can be difficult to eliminate entirely from a diet. It is also often found in items such as toothpaste, lip balm and even some vitamins.

Those who have celiac disease tend to have a variety of vitamin deficiencies so that doctors will prescribe a gluten-free multivitamin. Other medications may be provided to address secondary symptoms related to bone and joint health, dermatitis and ADHD. The Celiac Disease Foundation notes that there are more than 200 known celiac disease symptoms so that the complete treatment regimen can vary significantly across cases.

Celiac disease is projected to impact roughly 3 million Americans, though many more have gluten sensitivities.

Common Symptoms of Celiac Disease:

• Abdominal pain
• Diarrhea
• Constipation
• Weight loss
• Nausea
• Fatigue
• Sores in the mouth

Their Impact on People

Specific symptoms can help doctors understand the differences and make an appropriate diagnosis for a patient. A gastroenterologist can provide diagnosis through blood work, stool sampling, endoscopy or colonoscopy. The location of the inflammation is one of the most significant determining factors, while others can include the frequency and consistency of stool or diarrhea, the presence of blood and if a fever is present. All three may cause the patient to lose weight. However, celiac is the only one with weight gain as a common symptom.

All three are chronic diseases that the patient will need to learn to manage. Their impacts on health and daily lives are long-lasting and significant, and should be a focus of study and care, says Stephanie Bostic, Ph.D., RD.
“Celiac disease carries the fewest long-term complications when patients are able and willing to be adherent to the strict diet,” says Bostic. “While patients initially have higher risks of cancers and often have concurrent nutrient deficiencies at the time of diagnosis, when well-managed, their levels of risk normalize within about five years.”

Celiac patients must change the way they eat for all meals, and this can have a significant impact on the way they socialize. Bostic points to the recent increased availability of gluten-free foods as a positive step to helping these patients maintain a healthy, normal life, but notes that struggles remain when eating outside of the home.
The two IBDs often take a much larger toll on someone’s life and lead to significant long-term complications.

“Ulcerative colitis can be ‘cured’ through a surgery that removes the colon and rectum,” says Bostic. “This leads to a temporary period where people have to wear an ileostomy bag, but this can be easier than dealing with constant symptoms. Many people can manage with medications and lifestyle changes, however.”

The Crohn's & Colitis Foundation says some new surgical techniques remove the colon but do not require the ileostomy. The surgeon can create an internal pouch using the small bowel and attach it to the anal sphincter muscle to allow for the elimination of waste.

Crohn’s disease may have the most significant impact when looking at the patient population as a whole because the majority of people with the disease will require surgery at some point in their life. It often involves multiple surgeries and sometimes emergency hospitalizations.
Crohn’s is associated with high rates of urgency and incontinence, significantly impacting daily life. “Patients struggle most with sudden needs for a bathroom,” says Bostic. “In some cases, people are afraid to travel or do certain activities.”

Celiac, Crohn’s and ulcerative colitis all have significant impacts and implications on the lives of their patients. Understanding their differences and similarities can help doctors and patients with management of the diseases as well as help communities make changes that can benefit the lives of their residents.