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Can You Have BOTH Crohn’s Disease and Ulcerative Colitis?

You Can't Have BOTH Crohn's Disease and Ulcerative Colitis!

There. I said it.

You can’t. It is not possible to have both Crohn’s Disease and ulcerative colitis which has been confirmed over and over again by top IBD specialists and researchers worldwide. 

For some reason over the last decade this has become a very hot topic of debate amongst patients in the IBD community so I’d like to address this misconception, help you understand where it comes from, and provide you with accurate information to help you better understand IBD and why it isn’t possible for one person to have both Crohn’s disease and ulcerative colitis. 

Illustration of an 80s girl holding a megaphone with a text bubble that says "you can't have BOTH Crohn's and UC!"

If You Don't Want to Take My Word for It...

Before I go any further I am often met with the response that I am only a patient therefore I don’t know what I am talking about and to that I say @#!%*! fair enough. 

First I present to you this interaction between myself and Dr. Rubin over on Twitter. Dr. Rubin is an IBD specialist, Chief of GI, Hepatology, and Nutrition, and Co-Director of the Digestive Disease Center at University of Chicago Medicine. Hover over the first image to view explanation and click through to see images in a larger size. 

In addition, you can view this video by Dr. Neilanjan Nandi is an IBD specialist and Director of the Center for IBD at Drexel Medicine. His video goes over some myths about IBD and in it he addresses the misconception that you can have both Crohn’s disease and ulcerative colitis.

NOT JUST CROHN'S AND UC BUT 100s OF DISEASES?

In order to understand why you can’t have both Crohn’s and UC in the same person I think it’s important to better understand what Inflammatory Bowel Disease actually is. When a patient is diagnosed with IBD they receive a diagnosis of Crohn’s disease or ulcerative colitis and sometimes a person will receive a diagnoses of ‘IBD Unclassified’ which used to be known as indeterminate colitis

So wouldn’t that mean there are only 3 types of IBD? Nope. We receive one of those 

a digestive tract with CD and a digestive tract with UC

3 diagnoses according to the way our body expresses its IBD but over the years we have come to realize that IBD falls along a spectrum and there really could be hundreds of different kinds of inflammatory bowel diseases.  

Dr. Rubin helps describe this by saying, “We’ve labeled Crohn’s disease and ulcerative colitis as two diseases, but we’ve come to realize that there may be 50 to 100 different diseases that are all overlapping. The body can express itself in very specific and limited ways, so anything that results in overactive inflammation or some imbalanced immune response can look like one of these diseases.” 

To help you understand this you can take a look at the genes that are involved in IBD. Back in the early aughts the very first susceptibility gene to be associated with IBD, NOD2, was discovered. Since then over 200 genes have been discovered and that

genes involved in IBD
Slide from University of Chicago patient education night on the subject of Why We Haven't Cured IBD Yet

number keeps rising. Not all patients have every gene and every patient has different combinations of these genes which really highlights how unique we can be from each other. Like Dr. Rubin said in the tweets above, your IBD is YOUR IBD.

We can also look at what we think causes IBD aside from genetics. The current theory is that in addition to a genetic predisposition that microbiome, environment, and an immune dysregulation contribute to a person developing IBD. With millions of people across the world living with IBD you can now start to see just how complicated this can get. We all have different combinations of some of these genes and have differing microbiomes as well as environmental factors. Currently there is work being done to identify subtypes of IBD. I explain this and the importance of it in the video below. That video also helps explain

a more in-depth look into what IBD actually is.

We label IBDs as CD, UC, or IBD-U because we don’t have names for subtypes of IBD along the spectrum. One of the reasons we need a specific label is because the FDA approves drug therapies according to which kinds of IBDs respond to them. If a patient needs a medication that is approved for Crohn’s disease but is not approved for UC then they would need a diagnosis of CD in order to receive that medication. 

The way IBD gets classified in the future may change and I think it’s very likely it will but for right now we lump everyone’s IBD into a diagnosis of Crohn’s disease, ulcerative colitis, or IBD -unclassified. It’s more important to start thinking of them all as inflammatory bowel disease and drop this black and white thinking that there are just A, B, and C and it all looks and acts the same.

More Misconception Mishaps

  1. Crohn’s Colitis
U of Chicago presentation by Dr. Rubin on curing IBD

Sometimes people think they have both Crohn’s and UC when they are told they have Crohn’s Colitis

A diagnosis of Crohn’s colitis means that you have Crohn’s disease that is found only in your colon. The misunderstanding occurs when the person hears the word colitis and mistakenly thinks they have both Crohn’s and ulcerative colitis after they are told they have Crohn’s colitis. The word colitis simply means inflammation of the colon and there are many things that can cause colitis in addition to the IBD known as ulcerative colitis. Sometimes our doctors do not remember that most patients are not equipped with the understanding of medical jargon and need to be more diligent in how they explain their patient’s IBD. 

A diagnosis of Crohn’s colitis means IBD located only in the colon that is characteristic of Crohn’s disease and is therefore determined to be Crohn’s disease and not ulcerative colitis. Crohn’s colitis does not mean the person has both Crohn’s and UC.

2. Colitis vs Ulcerative Colitis

Another way a person might get confused into thinking they have both Crohn’s disease and ulcerative colitis is when they hear (or read in one of their medical records) about colitis they have. 

Like I mentioned above the word colitis means inflammation of the colon and there are several things that can lead to colitis in addition to IBD. Sometimes patients who have Crohn’s disease will get confused into thinking they have both because they have been talked to about their “colitis.” For example I have Crohn’s disease. Let’s say hypothetically that I went in for a scope and afterward my doctor told me he noticed some colitis throughout

my sigmoid colon. What he’s trying to tell me is that I have active inflammation in my colon (colitis) but that doesn’t mean that I have ulcerative colitis. It just means that my Crohn’s disease is causing inflammation in my sigmoid colon so he used the word ‘colitis’ when talking about it. I only have one IBD, Crohn’s disease, but it’s located in an area of my colon so my GI is describing it as colitis. It can be confusing and again I think our doctors need to work harder at making sure we understand IBD to the best of our ability.

3. The Internet

Last but certainly not least is the internet and the role it plays in the spread of this rumor. 

I started this post showing you how the large health website, Healthline contributed to this misconception. It’s easy to mistake a site like this as a reliable source of information but it’s important not to do so. The majority of articles are written by people who have no business educations others about IBD. What can be even more misleading is that this site and others like it have their articles medically reviewed by a doctor but in a lot of them the doctor

gif from the show Glow. The man is saying 'Everyone in this room is a liar'

reviewing the article doesn’t even specialize in the area of focus. 

Sites like these seldom care if they are getting it right, rather they care about the income it creates. Of course these are not the only contributors to the misconception. Uninformed patients also play a role in the spread of this misconception as they communicate online. 

All I’m saying is you cannot assume the information you are getting is correct. I even encourage people to question me and my site because even though I go to great lengths to educate myself and inform others there will inevitably be a mistake or two that I make. 

In Conclusion

IBD is actually a spectrum of diseases and patients fall all along that spectrum. IBD is complex and complicated and no two patients have the same Crohn’s disease or the same ulcerative colitis. Though the exact cause of IBD remains unknown it is likely that there are many contributing factors that make up your IBD. You personally only have one type of inflammatory bowel disease; you have YOUR IBD. You will be diagnosed with Crohn’s disease or ulcerative colitis (or in some cases indeterminate colitis) two distinct kinds of IBD, but YOUR Crohn’s disease will not be the same as someone else’s Crohn’s disease (or your UC will not be the same as someone else with UC) because the other person has different genetics, grew up in a different environment, has a different microbiome, etc.

Sara

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Now that you’ve read this article test your knowledge by clicking the link below and taking the quiz! 

Can A Person have Both Crohn’s Disease and Ulcerative Colitis?

This quiz is designed to be taken after reading my article on whether or not a person can have both Crohn's disease and ulcerative colitis. 

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