I'm going to visit my surgeon tomorrow and I'm having trouble distinguishing the difference between Crohn's and Ulcerative Colitis.

How is the differing diagnosis best made... by an endoscopic examination of the small intestine or by examining the symptoms?

One thing that keeps coming up in my research is the term "perianal disease". To the best of my ability, this seems to mean fissures, hemarroids, etc. What else would it entail? Can't someone with a pouch get fissures and/or hemarroids regardless if they had UC or Crohn's?

I'm confused...

Differential diangosis is made by a combination of findings: endoscopy with biopsy, x-ray imaging (barium enema, small bowel series, CT scans), symptoms, family history, and IBD serologies.

Perianal Cronn's disease is primarily fissures, strictures, fistulas and abscesses. I do not believe it includes hemorrhoids. The fissures of Crohn's are different than those in folks without IBD. They tend to be larger, deeper and produce strange skin tags. Sure, anyone who has had a rectal dissection can get these complications. However, if you had any of these before surgery and have IBD, it is more of an indicator of Crohn's. However, it is not diagnostic by itself. Plus, remember that with Crohn's, you can get abscess/fistula formation anywhere in the GI tract and it is not uncommon to develop them to the bladder or between loops of intestine.

Here are some good links for you:

http://www.merck.com/mmpe/sec02/ch018/ch018a.html

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&d...936009&dopt=Abstract

Jan

Jan,

Table 1 on the Merck link is very interesting. My indeterminate colitis was limited to the left side of my colon, which is an indication of colitis. However, I did have an abscess and fistula one time, which is indicative of Crohn's. No wonder they couldn't determine what I had!

Brian

Thanks again Jan.

You, my friend, are a rock star.

MichiganMan,

I was in a very similar situation with my diagnosis. The first surgical consult I had believed I had Crohn's and the GI believed I had Indeterminate Colitis. The reason that they suspected that it was not straight out Ulcerative Colitis was the fact that I had a larger fissure and a skin tag.

I want to caution you to make sure that your physician's do a full workup on you and that you get a 2nd consult if needed. It turned out in my case that both my GI and the 1st surgical consult were wrong about my case. They didn't look at other possibilities - and it turned out I had an underlying condition that made my symptoms area a bit different from a clear cut case of Ulcerative Colitis but all the while it was in fact Ulcerative Colitis.

There is a lot of difficulty in making this diagnosis, but I just want to encourage you to keep asking questions and pursue the diagnosis until there is very little or no dobut of your condition.

Rick