Modified: February 5, 2020

Dear @Name@,

Your healthcare team has discussed the following subject with you: causes of flares in inflammatory bowel disease. Here is some additional information. Let us know if you have any questions regarding this information.

A flare is a period of time when symptoms and inflammation from ulcerative colitis or Crohn's disease become active. These symptoms can include diarrhea, abdominal pain, and blood stools. 

Several factors can worsen inflammation in inflammatory bowel disease and cause symptoms:

  • Missing medication doses: Even when symptoms are in remission, people with inflammatory bowel disease need to continue to take their medications. Missing doses or taking the medication incorrectly can result in flares of symptoms

  • Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs include aspirin, naproxen, and ibuprofen - with brand names that include Aleve, Motrin, Aleve. These medications can cause flares and should generally be avoided.  For pain, acetaminophen (Tylenol) can be used up to 3000mg per day.

  • Antibiotics: In some circumstances, antibiotics can cause flares of symptoms. If you are prescribed antibiotics, confirm that this is for a bacterial infection and make your gastroenterologist aware before using the therapy.

  • Smoking: Smoking can increase the possibility of a flare in Crohn's disease. Keep in mind that this could include prolonged exposure to second-hand smoke. 

  • Infections: Sometimes, infection of the gastrointestinal tract (such as c. difficile) can cause flares of symptoms. Your doctor will oftentimes check for this in your stool if you have flares of symptoms. 

Other factors can worsen symptoms, without necessarily worsening inflammation:

  • Stress: Stress can worsen symptoms in patients with inflammatory bowel disease.  These symptoms include diarrhea and abdominal pain.

  • Foods: Certain foods can cause symptoms in patients with inflammation in inflammatory bowel disease.  There is no direct evidence currently that food can cause a flare in IBD. 

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