Skip to content 
A flare is the return of active IBD symptoms after a period of remission. Patients usually know what their flare looks like, because the symptoms tend to follow the same pattern that brought them to a doctor in the first place. Stool frequency rises, blood may reappear, abdominal pain creeps back, fatigue and weight loss follow if the flare runs long enough. The instinct to wait it out is one of the commoner mistakes patients make. Acting early shortens flares and prevents the damage that’s much harder to undo later.
According to Dr. Vipulroy Rathod, Gastroenterologist in Mumbai, “Patients wait too long. They hope it’ll settle on its own. Sometimes it does. Often it doesn’t, and what could have been managed with a steroid course or a biologic dose tweak in week one ends up needing hospitalisation by week four. Acting early when it turns out to be nothing costs much less than acting late when it turns out to be a major flare.”
What to do when symptoms return?
The first response isn’t a Google search. It’s a structured assessment, ideally with input from the gastroenterology team within days, not weeks.
- Document symptoms specifically. Stool frequency per day. Presence and amount of blood. Pain pattern. Weight change. Vague reports like “things are worse” don’t give the clinical team enough to work with.
- Check medication adherence honestly. Missed doses, stopped biologics, irregular maintenance therapy, these are the commonest preventable causes of flare. Patients are often reluctant to admit gaps, but the team needs to know because management changes depending on whether the flare comes from missed treatment or genuine breakthrough disease.
- Always rule out infection before escalating immunosuppression. Stool testing for C. difficile, bacterial pathogens, and parasites is non-negotiable before adding steroids. Giving steroids to a patient with superimposed C. difficile colitis makes things significantly worse.
Contact the gastroenterology team early. Many flares can be assessed remotely at first, with stool tests, blood markers, and history guiding the next step. IBD treatment plans should include clear flare instructions agreed in advance, telling patients which symptoms warrant immediate contact, what tests will be ordered, and what the escalation threshold looks like, so the response is structured rather than reactive.
What clinical assessment and escalation actually involves?
Once a flare is reported, the workup follows a familiar pattern. Confirm active inflammation. Rule out other causes. Decide how aggressively to escalate.
Stool tests come first because they answer the most important question quickly. Faecal calprotectin to quantify inflammation. Cultures and PCR for infection. Calprotectin above 250 in a patient with returned symptoms strongly suggests active disease. Under 100 raises the possibility that something else is going on entirely, sometimes IBS-like symptoms in patients with healed bowel, sometimes a non-IBD cause that’s been missed.
Blood tests cover inflammatory markers (CRP and ESR), full blood count, liver function, and a basic metabolic panel. Anaemia, low albumin, raised CRP all support active disease. In biologic patients drug levels go in at the same time, because the commonest reason for biologic failure isn’t drug resistance, it’s underdosing.
Imaging or endoscopy isn’t always needed at first contact. Mild to moderate flares are often managed on stool and blood tests alone in the early phase. Severe symptoms, suspected complications, or flares not responding to first-line treatment usually trigger CT enterography, MR enterography, or sigmoidoscopy depending on availability and what’s clinically most useful.
Treatment escalation runs on a ladder rather than a single decision. Optimise maintenance therapy. Add a short course of steroids if needed for symptom control. Consider biologic dose escalation or switching agents if the flare reflects genuine loss of response. Surgery for cases that don’t respond to medical rescue, or where complications have developed. Read more on when IBD needs surgery for how the surgical option fits into flare management when medical treatment isn’t enough.
Why choose Dr. Vipulroy Rathod for IBD flare management?
Dr. Vipulroy Rathod has been managing IBD flares and the longer trajectory of inflammatory bowel disease at Fortis Hospital Mulund for over three decades, with the kind of structured flare protocols that come from seeing the same patterns repeatedly and knowing which escalation works for which patient. Many patients arrive mid-flare having waited too long, when earlier intervention would have made the difference between outpatient management and a hospital admission.
The pattern that matters most in flare management is recognition. Patients who know what their flare looks like, who have a clear plan agreed with their team, who contact the clinic at day three rather than week three, consistently do better than patients trying to manage flares alone. The work upfront on agreeing what to do when symptoms return pays back many times over.
Book your consultation today with one of India’s most experienced specialists for IBD assessment and structured flare management.
Frequently Asked Questions
Within a few days. Don’t wait for symptoms to become severe. Early assessment gives the team more options than late assessment.
Sometimes, often not. Some flares respond to maintenance optimisation. Others need short steroid courses or biologic adjustment. Self-adjusting without team input risks under-treating or masking infection.
Faecal calprotectin and stool infection screen first. Then CRP, full blood count, liver function. Biologic drug levels if applicable. Most results come back within a few days.
Most flares are managed as outpatients. Admission is reserved for severe colitis not responding to oral treatment, complications like obstruction or perforation, or patients too unwell to manage at home.
Reference links-
- IBD Flare Management Guidelines, American Gastroenterological Association — https://gastro.org/clinical-guidance/
- ECCO Topical Review on IBD Flare, European Crohn’s and Colitis Organisation — https://www.ecco-ibd.eu/publications/ecco-guidelines.html
