Skip Lesions in IBD: Crohn’s Disease or Ulcerative Colitis?

Skip lesions are patches of inflammation along your intestines due to IBD. They’re more typical of Crohn’s disease but may also appear in newly diagnosed cases of ulcerative colitis.
Crohn’s disease and ulcerative colitis (UC) are two of the most common types of inflammatory bowel disease (IBD). These conditions cause long-term inflammation of parts of your gastrointestinal (GI) tract.
Though there are similarities in symptoms and treatments between Crohn’s disease and UC, skip lesions are more common in Crohn’s disease.
If you or a loved one is undergoing a diagnosis of IBD, a doctor may consider the presence of skip lesions. Here’s what you need to know to understand better what these lesions can mean for your diagnosis.

What are skip lesions in Crohn’s disease?

What are skip lesions in Crohn’s disease?
Crohn’s disease is a type of IBD that can cause inflammation along any part of your GI tract. The GI tract runs between the mouth and anus.
However, Crohn’s disease most commonly affects the area between the end of your small intestine and the beginning of your large intestine (aka colon). Chronic inflammation can cause the lining of these areas to lose their integrity, leading to damage.
With Crohn’s disease, damage along your intestines may “skip.” Having skip lesions means there are damaged areas in your intestines but also healthy and undamaged areas between them.
Crohn’s disease skip lesions don’t cause separate symptoms or require different treatment. However, one 2022 study found that skip lesions within the small intestine could increase the risk of disease recurrence in those who have resection surgeries.
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Does ulcerative colitis feature skip lesions?
Although not typical, UC can produce skip lesions. A 2014 study found that about 15.8% of people with UC have skip lesions. Researchers found that it was not uncommon to find skip lesions in people with a recent UC diagnosis.
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How do doctors detect skip lesions in Crohn’s disease?

How do doctors detect skip lesions in Crohn’s disease?
Skip lesions are key characteristics of Crohn’s disease. A doctor may detect these lesions during a colonoscopy or ileoscopy.
A colonoscopy uses a thin tube with a camera attached to the end of it to help examine your rectum and colon. An ileoscopy is performed at the same time as a colonoscopy, but the goal is to get a better look at your ileum, or lower part of your small intestine.
During these procedures, a doctor will likely also collect a tissue sample from the colon, ileum, or rectum for confirmation. This is called a biopsy.

What are other key differences between Crohn’s disease and UC?

What are other key differences between Crohn’s disease and UC?
Both Crohn’s disease and UC fall under the umbrella of IBD, and they share similar symptoms, such as:
abdominal cramps and pain
bloating
diarrhea
fever
fatigue
nausea or vomiting
unintentional weight loss
Skip lesions alone aren‘t enough for a doctor to diagnose Crohn‘s versus UC. Still, key differences between the two IBD types may help a doctor accurately diagnose which type you may have.
Crohn’s disease can affect any part of the GI tract, but UC impacts only your large intestine, comprising both your colon and rectum. This can, in turn, cause different symptoms between the two conditions.
For example, Crohn’s disease can also cause symptoms beyond your intestines, such as:
joint pain
skin lesions
eye symptoms
UC is more likely to cause symptoms related to your large intestine, such as blood or mucus in your stools and frequent urges to pass a bowel movement (tenesmus).
The goal of IBD treatment is to reduce damage-causing inflammation. This may involve medications, such as steroids, aminosalicylates, or immunomodulators. Severe IBD may require surgery.
A doctor may also recommend a bowel rest for severe Crohn’s disease. This involves a liquid-only diet and intravenous (IV) nutrition for a few days to weeks.
Can Crohn’s cause lesions elsewhere?
While GI symptoms are most common in IBD, Crohn’s disease may also sometimes lead to the development of lesions in your skin. These most often involve red or purple-colored tender bumps that can appear underneath your skin.
Types of skin lesions caused by Crohn’s disease include erythema nodosum, which are small and painful nodules that usually develop on your legs, and skin ulcers called pyoderma gangrenosum. Crohn’s disease may also cause rashes.
It’s also possible to develop perianal lesions, which consist of ulcers around the anal opening.
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Takeaway

Takeaway
Skip lesions are areas of diseased portions of your intestines that may be next to undamaged portions. This phenomenon is present in Crohn’s disease but not typical in UC.
If a doctor suspects you may have IBD, conducting imaging tests can help them determine which type of IBD you have. The presence of skip lesions is just one sign that you may have Crohn’s disease.
If you have skip lesions, work with a doctor to determine how to best treat your IBD. Decreasing the inflammation caused by this condition can help reduce your risk of related complications, such as intestinal fibrosis and obstruction.