WHAT IS A FLARE OR A DISEASE FLARE?

Unfortunately, Crohn's disease and ulcerative colitis (UC) aren't like sore throats or ear infections, where the illnesses go away after treatment. And that's why most people with the disease have to remain on treatment where the goal is to get them into remission. But even then, after periods when patients are doing well, these diseases can come back.  

Symptoms Can Return or FLARE

Crohn's and UC can gradually or even suddenly show up again with abdominal pain, diarrhea, bleeding or drainage from a fistula. This flare (in technical terms, recurrence or exacerbation) can result in a decreased appetite, weight loss, fatigue, a particular rash on the legs or even joint swelling and tenderness. Often those symptoms can be similar to what a patient had when the disease first came. But not always. New problems can be present, particularly when the disease has moved to a different area or worsened.

At the beginning, it can be difficult to be sure that the patient is having a flare. Other illnesses, like an ordinary virus, can start the same way. An infection, like Clostridium difficile (often called C diff), can also cause abdominal pain, diarrhea and even bloody stools. Stress can often trigger the pain and diarrhea typical of a flare of irritable bowel syndrome (IBS).  And it can be difficult to tell the two apart, except that IBS won't have blood or an abnormal intestine when a colonoscopy is done.

So a disease flare is when the symptoms are truly from Crohn's or UC, requiring treatment for IBD rather than treating for an infection or IBS.

Triggers

We often don't know why the disease flares (just like we often don't know why it started in the first place). But we do know certain triggers and sometimes doctors or patients suspect others, though they can't be proven. Those triggers seem to be different for different people: 

• Non-steroidal anti-inflammatory medicines (like ibuprofen, naproxen)
• Infections
• Not staying on prescribed medicines 
• Diet changes (though these are not consistent)
• Smoking
• Alcohol in abundance
• Stress (family, work, school, financial)

If a trigger can be found, you and your doctor can work together to correct the problem (treating an infection with an antibiotic or finding a way to relieve stress or making sure you take your medicines). If a cause can't be found, then your doctor has to determine the best options for you. This may include:

• Repeating some of the original tests or new ones 
  • to see if the disease has moved or worsened
  • to see if your medicine has stopped working and why
• Treating the inflammation that is causing the flare