From the Guidelines
Patients with Crohn's disease exacerbation typically experience severe symptoms, including at least 10 loose stools/day, daily abdominal pain, and anorectal symptoms such as pain, bowel urgency, incontinence, discharge, and tenesmus, as defined by the Crohn’s Disease Activity Index (CDAI) score of 220 or higher 1. These symptoms can be debilitating and significantly impact daily activities. The CDAI score is a standardized measure of disease severity, categorizing symptoms into remission, mild to moderate, moderate to severe, and severe 1. Some key symptoms of a Crohn's disease exacerbation include:
- Severe abdominal pain
- Frequent diarrhea, often with blood
- Anorectal symptoms such as pain, bowel urgency, incontinence, discharge, and tenesmus
- Systemic symptoms like fever, fatigue, and weight loss
- Increased inflammation, which can lead to complications like intestinal blockages or fistulas if left unmanaged 1. It is essential to recognize these symptoms to seek medical attention and adjust management strategies during flare-ups, ultimately improving morbidity, mortality, and quality of life.
From the Research
Symptoms of Crohn's Disease Exacerbation
The symptoms of a Crohn's disease exacerbation can vary, but common presenting symptoms include:
- Diarrhea
- Abdominal pain
- Rectal bleeding
- Fever
- Weight loss
- Fatigue 2 In addition to these symptoms, patients with Crohn's disease may also experience extraintestinal complications, such as arthritis, eye inflammation, and skin rashes.
Factors Contributing to Exacerbation
Several factors can contribute to a Crohn's disease exacerbation, including:
- Stress, which can exacerbate symptoms and increase the frequency of flare-ups 3
- Lack of social support, which can amplify stress levels and increase the risk of flare-ups 3
- Smoking, which can worsen symptoms and increase the risk of complications 2
- Infections, which can trigger a flare-up 4
- Non-adherence to treatment, which can lead to a loss of disease control and increased risk of complications 5, 6, 4
Treatment of Exacerbation
Treatment of a Crohn's disease exacerbation typically involves a stepwise approach, with the goal of rapidly reducing symptoms and preventing complications. Initial treatment may include:
- Intravenous steroid therapy, which can lead to improvement within 72 hours 4
- Biologics, such as tumor necrosis factor (TNF)-α inhibitors, α4ß7 integrins, interleukin (IL)-12/23 or IL-23 inhibitors, and Janus kinase (JAK) inhibitors 5, 6, 4
- Immunomodulators, such as azathioprine and mercaptopurine 5, 6
- Surgery, which may be necessary in cases of severe complications, such as bowel obstruction or abscesses 5, 6, 4