Dr Eman Al-Sualis — the symptoms of ulcerative colitis and Crohn's disease: what to look for
A focused one-minute primer on the clinical presentation of inflammatory bowel disease — the rectal-bleeding, tenesmus, and bloody diarrhoea pattern of ulcerative colitis versus the abdominal pain, weight loss, and extra-intestinal complications more typical of Crohn's disease.
Topics covered
"Bloody diarrhoea and tenesmus point toward ulcerative colitis; pain, weight loss, and perianal disease point toward Crohn's — and any extra-intestinal manifestation should make you think IBD until proven otherwise."
Show notes
Dr Al-Sualis opens with the ulcerative colitis picture. The classic UC patient presents with bloody diarrhoea, urgency, tenesmus, and lower abdominal cramps that improve with passing stool. Symptoms map to the extent of colonic involvement — proctitis at one end of the spectrum, pancolitis at the other — and severity is graded by stool frequency, blood, systemic features, and inflammatory markers.
Crohn's disease presents differently because the inflammation is transmural and can involve any segment from mouth to anus. The dominant symptoms are abdominal pain (often right lower quadrant with terminal ileal disease), weight loss, fatigue, and chronic diarrhoea — usually without the bright red blood seen in UC. Perianal disease (fistulae, abscesses, fissures), oral aphthous ulcers, and growth failure in younger patients are clues that point specifically toward Crohn's.
Dr Al-Sualis closes with the extra-intestinal manifestations every clinician should remember: joint pain (peripheral and axial arthropathy), skin (erythema nodosum, pyoderma gangrenosum), eyes (uveitis, episcleritis), and primary sclerosing cholangitis. Any of these in a patient with chronic GI symptoms — especially with rectal bleeding, weight loss, or anaemia — warrants gastroenterology referral and an IBD workup.