Understanding the remission and relapse cycle in Crohn’s disease
The main goal of Crohn’s disease treatment is to achieve and maintain remission.
Remission can mean different things based on the parameters used to describe it. Types of remission include:
This is the term your doctor will typically use to describe your remission. It means your symptoms have improved or gone away. Yet you may still have inflammation in your GI tract.
This means there is no evidence of inflammation on tests like a colonoscopy or sigmoidoscopy.
This type of remission is harder to achieve than clinical remission, but it’s the goal of treatment because it means the damage to your GI tract has stopped.
There’s no sign of inflammation on an MRI scan or other imaging scans of your GI tract.
Though there is no agreed-upon definition for this type of remission, it generally refers to reduced inflammation and healing in the lining of the GI tract.
Normal markers of inflammation
Blood and fecal tests show no signs of inflammation.
Symptoms like belly pain, diarrhea, and bloody stools should get milder or disappear once you’re in remission.
Periods of remission can last anywhere from a few months to several years. Yet symptoms usually come back at some point.
Being in remission doesn’t mean that you should stop treatment. Continuing to take your medication can help prevent a new flare of symptoms as well as complications.
Drugs used to maintain remission include:
- Aminosalicylates (5-ASAs) like sulfasalazine (Azulfidine). These drugs block certain pathways to bring down inflammation in the lining of the intestine.
- Immunomodulators such as azathioprine (Azasan). These drugs reduce the immune system response to stop inflammation. You may get one of these medications if the aminosalicylates didn’t work for you.
A few diets have been suggested for maintaining remission:
- Gluten-free diet. Gluten is a protein found in grains like wheat, barley, and rye. Some people with Crohn’s disease find that cutting gluten out of their diet helps with symptoms.
- Low fiber diet. Cutting back on high-fiber foods like whole grains, nuts, and popcorn may relieve symptoms like belly pain and loose bowel movements.
- Low FODMAP diet. FODMAP is shorthand for five sugars that your intestines may not absorb well. You’ll find them in foods that contain natural sugars like sorbitol and xylitol, as well as in chickpeas, lentils, garlic, and wheat.
- Low red processed meats diet. Some people find that when they cut back on beef and other red meat, as well as lunch meat, hot dogs, and bacon, they don’t get as many flares.
- Mediterranean diet. This diet is high in fruits, vegetables, fish, olive oil, and low-fat dairy and low in red meat.
- Specific carbohydrate diet. This diet cuts out certain sugars, as well as fiber and some grains.
So far, none of these diets has been proven to maintain remission, but they may work for certain people. Talk to your doctor or a dietitian before changing the way you eat.
Even with treatment, people with Crohn’s disease will likely experience flare-ups, or periods of time when their disease symptoms are active.
It’s not always possible to know what causes a flare. Flares can happen even while you’re taking your medications as prescribed.
Certain factors tend to trigger flares. Here are a few things you can do to avoid a return of your symptoms:
- Control stress. Stressful situations or strong emotions can lead to flare-ups. It’s impossible to eliminate all stress-producing events in your life, but you can use relaxation techniques like deep breathing and meditation to change the way your body reacts to stressful situations.
- Take all your medications. Many people with Crohn’s disease take medications on a daily basis, even during periods of remission. It’s not uncommon to miss some medication doses, but long periods of not taking prescribed medications can lead to flare-ups.
- Avoid nonsteroidal anti-inflammatory drugs (NSAIDs). Some commonly used medications, including aspirin, naproxen (Aleve), and ibuprofen (Motrin, Advil), are possible triggers for flares.
- Limit antibiotics. Using antibiotics can cause changes in the bacteria that normally live in the intestine. This can lead to inflammation and symptom flares in some people with Crohn’s.
- Don’t smoke. People who smoke tend to have more flares than nonsmokers.
- Watch your diet. Some people have diet-related flare triggers. No one type of food aggravates symptoms in everyone with Crohn’s. Keeping a food diary to identify any potential triggers can help you to better understand how your diet relates to your symptoms.
Symptoms of a relapse can vary from mild cramping and diarrhea to severe abdominal pain or bowel blockages. You may experience the same types of digestive problems you had when you were first diagnosed, or you may have new symptoms.
Typical symptoms during a flare include:
- frequent bowel movements
- blood in the stool
- belly pain
- nausea and vomiting
- weight loss
Symptom flare-ups can last from weeks to months.
Read Understanding the remission and relapse cycle in Crohn’s disease by Stephanie Watson.