Expert Perspectives on the Optimal Management of Inflammatory Bowel Disease - Episode 5

Differentiating Between Crohn’s and Ulcerative Colitis

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Best practices for distinguishing between Crohn’s disease and ulcerative colitis when assessing patients who present with symptoms of inflammatory bowel disease and counseling patients and loved ones on treatment selection and goals. 

Stephen Hanauer, MD: One of the issues that you mentioned is differentiating ulcerative colitis and Crohn disease. Ulcerative colitis being a diffused continuous superficial process starting in the anal verge and extending proximally, and Crohn disease being able to impact virtually anywhere in the digestive tract. You mentioned that in young kids, many patients develop a colitis to begin with, and we become more confident or satisfied with the diagnosis of indeterminate colitis. The problem is patients and their parents want a diagnosis. How do you handle that?

Marla Dubinsky, MD: I talk to them the way that we talked about, whereby there’s a spectrum of biology. I talk to them about the fact that even with an adult who goes to colectomy, I’m sure Steve you could agree, you can’t say with 100% certainty that they’re not going to develop Crohn-like inflammation of the pouch. We can’t, there’s too much overlap, right?

Stephen Hanauer, MD: There’s a pathologist from the Cleveland Clinic previously who said, there’s nothing like an ileoanal anastomosis to bring out the Crohn disease in someone.

Marla Dubinsky, MD: I resonate with that statement. Obviously, we may be biased because we see a higher level or more complex patients, but I do feel that I can’t at this point tell them with certainty. What I try to explain is that we focus less on the categories, but we focus on therapies that work predominantly in a more colitis-type phenomena and walk them through that this is something you cannot predict. We’re hopefully in the future going to get better biomarkers or a better way of knowing that before we send them to colectomy. But it’s not 100%, it just isn’t, and that’s what I’m honest about. I don’t want to be telling them that you’re done, drop the mic, no more therapies and no more issues, and just remove the colon. That would be a false sense of security in my opinion.

Transcript Edited for Clarity