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Unlike ulcerative colitis, which is limited to the colonic mucosa, Crohns disease features skip lesions areas of diseased bowel separated by segments of normal-appearing tissue and may involve multiple layers of the intestinal wall, leading to fibrosis, stricture formation, and fistulization, as described by the Crohns & Colitis Foundation

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Ongoing use of medications that treat acid reflux or gastroesophageal reflux disorder (GERD) can interfere with this process and cause low B12 levels