How to Shorten a Crohn’s Disease Flare-Up

Crohn's disease is a type of inflammatory bowel disease (IBD). It can cause a wide range of symptoms, from abdominal pain to arthritis. Symptoms tend to follow a relapsing-remitting pattern, in which they flare up for a while before improving.

Biologics and other drugs can manage Crohn's, but flares may still occur. When they happen, you may need to adjust your treatment plan with your doctor's help.

The following may help you shorten the length of a flare or reduce its severity.

Treatment can consist of short-term therapies for use during flares as well as long-term maintenance therapy. Treatment during a flare aims to relieve symptoms and bring about remission, or the end of the flare.

Anti-Inflammatory Drugs for Short-Term Use

During a flare, short-term use of anti-inflammatory drugs, such as steroids, can help improve symptoms by reducing inflammation. Your doctor may prescribe them alongside other drugs.

• Corticosteroids Prednisone (Deltasone) and budesonide (Entocort EC) can relieve symptoms and bring about remission. But long-term steroid use can have severe adverse effects, so doctors generally recommend using them for short periods as a bridge to other therapies.

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Pain-Relieving Medication

Pain-relieving medications won't shorten a Crohn's flare, but they can decrease discomfort while you wait for other drugs to work. These include:

• Antispasmodics, such as dicyclomine (Bentyl), which reduce cramps
• Acetaminophen, such as Tylenol, which relieves pain

Biologics and Other Long-Term Treatments

• Anti-TNF agents such as infliximab (Remicade) and adalimumab (Humira) can shorten a flare. These biologic drugs dampen the immune response by targeting specific molecules and blocking the action of a protein known as tumor necrosis factor, which causes inflammation.

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• IL-12/23 and IL-23 inhibitors such as ustekinumab (Stelara) and risankizumab (Skyrizi), respectively, are also biologic drugs. They reduce inflammation by blocking proteins known as interleukins, which play a role in activating the body's immune response.

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• Integrin blockers reduce Crohn's-related inflammation by targeting precise molecules linked to the gut. Vedolizumab (Entyvio), a biologic drug, blocks the production of one type of integrin, a protein that enables inflammation-causing cells to move from the blood into tissues. It can also act as a maintenance drug between flares.

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• JAK inhibitors, which are nonbiologic synthetic small molecule drugs, may relieve symptoms more quickly than other nonsteroid drugs. They reduce inflammation by blocking substances that lead to a faulty immune response, and they can also prevent recurrent flares.

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  In clinical trials, 58.8 percent felt symptom relief after two weeks.

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   Upadacitinib (Rinvoq) was the first JAK inhibitor to get approval from the U.S. Food and Drug Administration (FDA) for treating Crohn's.

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• Immunomodulators such as methotrexate (Trexall) and azathioprine (Imuran) are nonbiologic drugs that reduce inflammation by changing how the immune system works. But it can take 8 to 12 weeks to see an improvement after you start immunomodulators, so they're not typically used alone for treating acute flares.

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Will My Meds Change During a Flare?

A Crohn's flare doesn't necessarily mean your medication regimen has stopped working or that you'll have to change it, says Sobia Mujtaba, MD, MPH, a gastroenterologist and an assistant professor at the Emory University School of Medicine in Atlanta.

“While that is one reason for a flare, [that] a certain medication has lost efficacy, other reasons include infections, or if a medication needs to be optimized,” she says.

Drugs to Avoid

Speak with your doctor before starting or changing any drug or treatment, including over-the-counter drugs, to make sure they won't worsen your symptoms or interact with other medications.

Dietary and nutritional measures can help you manage a Crohn's flare. As always, speak with your doctor before making any changes to avoid potentially worsening your symptoms.

Foods to Eat or Avoid

“Patients often report a loss of appetite during a flare,” Dr. Mujtaba says. “I advise [them] to stay well hydrated, eat smaller meals throughout the day, and to consume their food as smoothies and purees. These are often more tolerable than solids during a flare.”

• Avoid foods that trigger your symptoms; a diary may help you keep track.
• Avoid highly processed foods, especially those with artificial sweeteners and other additives.
• Drink plenty of fluids, especially water.
• Opt for nutrient-dense snacks, such as smoothies, or crackers with nut butter.
• Adjust your fiber intake if continuing with your usual regime makes things worse.
• Focus on getting the nutrients you need to help your body heal and prevent complications.
• Follow meal planning tips for people with IBD.

• Cereals
• Plain white rice
• Boiled potato
• Cooked vegetables
• Broth soups
• Bananas
• Tofu
• Eggs
• Natural yogurt
• Cottage cheese
• Avocado
• Skinless chicken
• Fish
• Applesauce

Ask your doctor or a nutritionist to help you make a plan to meet your individual needs during a flare.

Supplements

“Supplements should be [taken] on the recommendations of the gastroenterologist,” Mujtaba says. “Patients with Crohn's disease can have a variety of nutritional deficiencies that may require supplements, such as vitamin D, vitamin B12, [or] iron.”

Bowel Rest

Depending on your needs, your doctor may prescribe:

• A liquid to drink that contains the nutrients you need.
• A nutrient-rich liquid that passes directly through a tube into your stomach or small intestine.
• Nutrients to be fed into a vein in your arm.

Bowel rest can last from a few days to several weeks.

• Take all your medications precisely as your doctor tells you to.
• See your doctor as often as they recommend.
• Contact your doctor if you have any concerns about symptoms, medication, and so on.
• Complete any blood tests and other tests your doctor recommends.
• Track your symptoms between appointments with an app like My IBD Care.

Life with Crohn's can be stressful, especially during a flare.

• Seek medical help for mental health issues, whether medication, therapy, or both.
• Use techniques such as relaxation and breathing exercises.
• Do gentle exercise, like yoga.
• Try mindfulness and meditation techniques.
• Use biofeedback to identify actions that may worsen symptoms.
• Take steps to manage fatigue.

The Crohn's & Colitis Foundation's IBD Help Center can advise you by phone, email, or live chat.

• An intestinal blockage
• Abscesses
• Fistulas, or tunnels that form between two parts of the body, allowing leakage from the gut and an increased risk of infection
• Anal tears, which can cause pain, itching, and bleeding
• Ulcers in your digestive system, including your mouth or intestines
• A worsening of non-gut symptoms, such as Crohn's-related arthritis

Unexpected problems that may arise depend “on the severity and nature of the flare,” Mujtaba says. “There can be a range of complications including anemia from blood loss, dehydration from diarrhea, [or] damage to the integrity of the gut wall, which can result in perforations [and] severe infections that need hospitalization.”

If you notice unusual pain, bleeding, or other signs of complications, speak with your doctor. You may need additional treatment or a review of your therapy.

• Signs of a flare
• Blood in your stool
• Weakness or fatigue
• Drastic weight loss
• Signs of an infection, like a fever
• Uncontrollable diarrhea

You should also contact your doctor if you don't think your medications are working. You may need to review your drug regimen.

• Without medical help, a Crohn's flare can be a lengthy and painful experience and may lead to complications.
• The right nutrition can be challenging during a flare, but it also strengthens your body during the healing process and prevents complications.
• Addressing anxiety, depression, and other impacts of Crohn's on your mental health may also help your body heal.
• Be sure to follow all medical guidance and contact your doctor at once if you notice a flare starting or if you have concerns about your symptoms, treatments, or other issues.