What is a flare and how does it pertain to us? Ashley and Rebecca from The Crohn's & Colitis Dietitians take a deep dive into understanding what the literature says according to The Manitoba Living with IBD study in the IBD Journal from Crohn's and Colitis Foundation. This study followed people for one year and evaluated their self reported symptoms and their fecal calprotectin, which indicates if there is active inflammation in the bowel. This study looks at a question we get a lot in our practice: how do we know if it's a flare/inflammation and how do we know if it's a symptom? Interestingly, the study showed half of the patients who felt like they were in a flare did not have inflammation and some people who had no symptoms had inflammation.
We discuss how this can provide some relief because although our symptoms and how we feel is valid, they may not always be a complete measure of how we're actually doing. If patients are feeling symptoms, such as urgency or cramping, this doesn't always indicate that we should panic and think we are going into a flare. Even though symptoms can be valuable indicators and we want to listen to our bodies, we have found that when we aren't hyperfocusing on symptoms, it is easier to take action and have a clear mind about what step to take next.
We also discuss the four types of remission in this episode and discuss how everyone is different and there is no clear cut answer as to how symptoms relate to IBD. We hope this study gives patients a little permission to ease up and remember we're doing the best we can.
A big takeaway is that there are so many variables in assessing IBD and mucosal healing is the goal, so we need to be proactive about our health and get the labs and the scopes done because only looking at symptoms does not give us the complete picture of how we are doing.
This also highlights that healing takes time and improving our nutrition has a longer term outcome.