Features differentiating between ulcerative colitis and Crohn disease

	Ulcerative colitis	Crohn disease
Clinical features
Hematochezia	Common	Less common
Passage of mucus or pus	Common	Rare
Small bowel disease	No (except backwash ileitis)	Yes
Can affect upper gastrointestinal tract	No*	Yes
Abdominal mass	Rare	Sometimes in right lower quadrant
Extraintestinal manifestations	Common	Common
Small bowel obstruction	Rarely	Common
Colonic obstruction	Rarely	Common
Fistulas and perianal disease	No^¶	Common
Biochemical features
Antineutrophil cytoplasmic antibodies	Common	Less common
Anti-Saccharomyces cerevisiae antibodies	Rarely	Common
Pathologic features
Transmural mucosal inflammation	No	Yes
Distorted crypt architecture	Yes	Yes
Cryptitis and crypt abscesses	Yes	Yes
Granulomas	No^Δ	Yes (seen in 25 to 40% of mucosal biopsies)
Fissures and skip lesions	Rarely^◊	Common

This table describes typical features distinguishing between classic ulcerative colitis and Crohn disease. On occasion, patients with ulcerative colitis may have "nonclassic" features, including gastritis and mild perianal disease, as discussed separately^[1].

* Some patients with ulcerative colitis may have mild upper gastrointestinal tract inflammation.
¶ Small anal skin tags are sometimes seen in ulcerative colitis; this finding does not constitute perianal disease.
Δ Rarely, patients with ulcerative colitis may have granulomas associated with ruptured mucosal crypts (sometimes termed "cryptolytic" granulomas). True granulomas that are associated with Crohn disease are well defined and epithelioid^[2]. The 2 types of granulomas are sometimes difficult to distinguish.
◊ In ulcerative colitis, patchy inflammation or skip lesions are sometimes noted during treatment. Some patients with ulcerative colitis have periappendiceal inflammation (sometimes called a "cecal patch") in the absence of pancolitis^[1].

References:

Bousvaros A, Antonioli DA, Colletti RB, et al. Differentiating ulcerative colitis from Crohn disease in children and young adults: report of a working group of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the Crohn's and Colitis Foundation of America. J Pediatr Gastroenterol Nutr 2007; 44:653.
Mahadeva U, Martin JP, et al. Granulomatous ulcerative colitis: a re-appraisal of the mucosal granuloma in the distinction of Crohn's disease from ulcerative colitis. Histopathology 2002; 41:50.

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Features differentiating between ulcerative colitis and Crohn disease