What characterizes an acute Crohn's flare?

From the Guidelines

An acute Crohn's flare is characterized by a sudden worsening of symptoms including severe abdominal pain, persistent diarrhea, significant fatigue, unintended weight loss, and fever, as noted in the most recent study 1. The symptoms of an acute Crohn's flare can be heterogeneous, but typically include:

• Severe abdominal pain (often in the lower right quadrant)
• Persistent diarrhea (which may contain blood, mucus, or pus)
• Significant fatigue
• Unintended weight loss
• Fever
• Nausea, vomiting, reduced appetite, and symptoms outside the digestive tract such as joint pain, skin rashes, or eye inflammation.

During a flare, laboratory tests typically show elevated inflammatory markers like C-reactive protein and erythrocyte sedimentation rate, while stool tests may reveal increased calprotectin levels indicating intestinal inflammation, as discussed in 1 and 1.

Treatment for an acute flare often includes:

• Corticosteroids like prednisone (typically 40mg daily, tapered over 8-12 weeks) or budesonide (9mg daily for 8-12 weeks) for moderate flares
• Hospitalization for intravenous steroids (methylprednisolone 40-60mg daily), antibiotics if infection is suspected, and possibly biologics like infliximab (5mg/kg at weeks 0,2, and 6) or adalimumab (160mg initially, 80mg at week 2, then 40mg every other week) for severe flares, as mentioned in 1.

These medications work by suppressing the overactive immune response causing inflammation in the intestinal wall. Patients experiencing a flare should maintain hydration, consider a low-residue diet to reduce bowel irritation, and contact their healthcare provider promptly as untreated severe flares can lead to complications like strictures, fistulas, or abscesses requiring surgical intervention, as highlighted in 1 and 1.

From the Research

Characteristics of Acute Crohn's Flare

• Acute exacerbations of Crohn's disease are characterized by symptoms such as diarrhea, abdominal pain, fever, anorexia, intestinal bleeding, and weight loss 2
• Immune-mediated diseases that are frequently associated with Crohn's disease include arthritis, ankylosing spondylitis, sacroiliitis, episcleritis, uveitis, and skin lesions, such as erythema nodosum and pyoderma gangrenosum 2
• Active disease symptoms include abdominal pain, fatigue, weight loss, and diarrhea 3
• Abdominal pain in Crohn's disease could be a symptom of disease relapse or related to medication adverse effects, surgical complications, and strictures or adhesions secondary to IBD 3

Clinical Presentation

• Common presenting symptoms include diarrhea, abdominal pain, rectal bleeding, fever, weight loss, and fatigue 4
• Physical examination should identify unstable patients requiring immediate care, include an anorectal examination, and look for extraintestinal complications 4
• Initial laboratory evaluation identifies inflammation and screens for alternative diagnoses 4

Diagnosis and Management

• Diagnosis is confirmed by endoscopy and cross-sectional imaging, and treatment decisions are guided by disease severity and risk of poor outcomes 4
• Patients commonly receive corticosteroids to treat symptom flare-ups, and patients with higher-risk disease are given biologics, with or without immunomodulators, to induce and maintain remission 4
• Medical treatments, lifestyle interventions, and surgical interventions are used to induce and maintain remission in adults with Crohn's disease 5