Key Difference – Celiac vs Crohn’s Disease
The main difference between Celiac and Crohn’s disease is that the Celiac disease is an autoimmune disorder that can occur among genetically predisposed people where the ingestion of gluten leads to damage in the small intestine; it results in villus atrophy and malabsorption. Whereas, the Crohn’s disease is a chronic inflammatory disease of the intestines, especially the colon and ileum, associated with ulcers and fistulae. This is characterized by strictures of the small bowel with skip lesions. Terminal ileum is a common site of involvement. This article attempts to clarify the difference between the two diseases in more detail.
What is Celiac Disease?
When people with celiac disease eat gluten-containing food (a protein found in wheat, rye, and barley), their body mounts an immune response towards the epithelium of the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that facilitate nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly which leads to malabsorption syndrome. Celiac disease can lead to other serious health problems such as autoimmune disorders like type I diabetes and multiple sclerosis (MS), dermatitis herpetiform (an itchy skin rash), anemia, osteoporosis, infertility and miscarriage, neurological conditions like epilepsy and migraines, short stature, and intestinal cancers.Currently, the treatment for celiac disease is lifelong adherence to a gluten-free diet.
What is Crohn’s disease?
Crohn’s disease is caused by a combination of environmental, immune and bacterial factors in a genetically susceptible individual. It results in a chronic inflammatory reaction, in which the body’s immune system attacks the gastrointestinal tract possibly directed at microbial antigens. It results in abdominal pain, bloody diarrhea that has multiple relapses and remissions. Other complications include intestinal strictures and obstruction, fistulae, abscesses. It is also associated with multiple systemic manifestations such as red eyes, arthritis, skin manifestations like erythema nodosum, gallstones, and biliary stones. Treatment is by immune suppressants such as steroids, sulfasalazine, and mesalazine. Antibiotics also have a role in the management. Surgery is required for complicated patients where resection of the involved bowel is needed to relieve obstructions.
What is the difference between Celiac and Crohn’s Disease?
Cause:
Celiac Disease: Celiac disease is caused by hypersensitivity to gluten.
Crohn’s Disease: Crohns diseases is caused by the autoimmune reaction against intestinal epithelium.
Celiac Disease:
Symptoms:
Celiac Disease: Celiac disease causes malabsorption syndrome.
Crohn’s Disease: Crohn’s disease causes relapsing and remitting diarrhea with other systemic inflammatory manifestations like arthritis, episcleritis, and pyoderma.
Autoantibodies:
Celiac Disease: Anti-Endomysial Antibodies are found in some patients with celiac disease.
Crohn’s Disease: Anti–Saccharomyces cerevisiae antibodies are found in some patients with Crohn’s disease.
Histology:
Celiac Disease: Celiac disease causes villous atrophy mainly in the jejunum. Only the mucosa is affected.
Crohn’s Disease: Crohn’s disease causes cobblestone appearance with epitheloid type granuloma formation. It affects all layers of the intestinal wall.
Commonest Site:
Celiac Disease: Celiac disease commonly affects the jejunum.
Crohn’s Disease: Crohn’s disease commonly affects terminal ileum.
Diagnosis:
Celiac Disease: Celiac disease needs endoscopy and jejunal biopsy. Autoantibody detection will support the diagnosis.
Crohn’s Disease: Crohn’s disease is diagnosed by lower gastrointestinal endoscopy and biopsy. When the terminal ileum is not involved barium studies and CT enterography may be required to detect distal lesions.
Treatment:
Celiac Disease: Celiac disease needs a lifelong gluten-free diet.
Crohn’s Disease: Crohn’s disease needs immunosuppressants. There are new modalities of treatments such as monoclonal antibodies that are under trials.
Image Courtesy:
1. Celiac Disease High Map By Nephron (Own work) [CC BY-SA 3.0 or GFDL], via Wikimedia Commons
2. Crohn’s disease – colon – intermed mag By Nephron (Own work) [CC BY-SA 3.0 or GFDL], via Wikimedia Commons
