Living with Crohn's disease: Recognizing and managing flares

Crohn's disease is an inflammatory condition that can affect any part of the gastrointestinal tract. Together with ulcerative colitis, Crohn's is one of the two main types of inflammatory bowel disease (IBD). Crohn's affects approximately 500,000 Americans and is a chronic, lifelong condition that typically alternates between periods of relatively stable or absent symptoms (remission) and periods of symptom flare-ups that can last for days, weeks, or even months.

The goal of treatment is to induce remission and then to maximize the chance that patients stay in remission. However, almost everyone with Crohn's disease will experience a flare-up at some point. If you have Crohn's disease, it is important to understand what you can do to reduce the risk of a flare, to recognize symptoms of a flare, and to manage flares when they do happen.

Tracking symptoms helps recognize Crohn's disease flares early

Flare-ups can be triggered by a variety of factors including changes in diet, new medications, infections and antibiotics, stress, and changes in the underlying disease itself. In some cases a specific trigger can be identified, but in many cases the trigger remains unknown.

Symptoms of Crohn's disease can vary widely. Some people primarily have abdominal pain and diarrhea, while others may have lack of appetite, nausea, or abdominal distension, and still others may have less specific symptoms such as fatigue, joint pain, mouth ulcers, or eye symptoms.

The key is to have a good sense of your baseline symptoms at remission, and how your Crohn's disease manifests when it is more active. A number of smartphone apps, including Oshi: IBD tracker and myColitis, can help patients better monitor their condition, prompting you to track things like bowel movements, symptoms, and medications. The Crohn's and Colitis Foundation has developed an easy-to-use symptom tracker. These types of records can help you provide your gastroenterologist with a more complete picture of your disease activity between office visits.

Contact your doctor at the first sign of a flare

You should contact your doctor if you think you are experiencing a flare so he or she can test to see if the flare is due to an infection, or determine if any new medications or exposures, such as recent antibiotics, might have triggered the flare. In the absence of infection or another reversible cause of the flare, your gastroenterologist may recommend a treatment course of corticosteroids, either topical (applied to the lower colon through enemas or suppositories) or systemic (body-wide).

Symptom flares can also indicate a change in your body's response to your current treatment. For example, each year a portion of patients who take either immunomodulator or biologic medications such as infliximab (Remicade) or adalimumab (Humira) stop responding to their medication. Sometimes a major symptom flare can signify that these medications are no longer working. Your doctor can perform tests to confirm if this is the case and, if necessary, switch you to a different medication.

Dietary and lifestyle changes can help manage Crohn's disease flares

There are a number of additional measures you can take to help manage flares when they do occur.

Avoid NSAIDs. Nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen (Advil) or naproxen (Aleve) can impair the ability of the GI tract to protect and heal itself, and can precipitate a flare. If you are having pain, take acetaminophen (Tylenol) instead of NSAIDs.

Quit smoking. Smoking is a strong risk factor for developing Crohn's disease and can also set off a disease flare. Quitting smoking is strongly associated with fewer flares, decreased medication requirements, and reduced risk of surgery.

Reduce stress. Although stress does not directly cause Crohn's disease, it does strongly impact IBD symptoms. Many people with Crohn's disease find the regular use of stress management and stress reduction techniques to be helpful. These can include meditation, deep breathing, biofeedback, yoga, and cognitive behavioral therapy.

Simplify your diet. There is no specific diet that prevents or cures Crohn's disease, but you may identify specific foods that tend to worsen your symptoms. Keeping a food journal can help you make these connections. There are also several general principles that help most patients feel better when they are experiencing a flare:

• Eliminate dairy.
• Avoid greasy and fried food.
• Limit foods that are high in fiber, such as raw vegetables and whole grains.
• Avoid foods that tend to cause gas (beans, cruciferous vegetables).
• Limit your diet to well-cooked vegetables.

Minimize caffeine and alcohol. They may make symptoms worse during a flare.

The bottom line

Most people with Crohn's disease will experience a flare at some point, even if they take their maintenance medications as directed. Carefully monitoring and tracking symptoms every day will help you recognize a flare-up when it begins. Let your gastroenterologist know about a flare-up and to be sure to follow recommendations for medications and tests. Dietary and lifestyle modifications can also help manage flare-ups when they do occur.