Is There a Seasonal Pattern with Crohn's Flare-Ups?

Hospital charts suggest it is real. Soaring numbers of visits to gastroenterologists' offices cannot be overlooked.

One of the most frustrating aspects of Crohn's disease for both patients and physicians is proving the predictability of seasonal flares. Doctors' offices pile up with individuals suffering from inflammatory bowel disease (IBD) in both autumn and spring in climates with definite changes in the seasons. Yet study upon study reports unremarkable data to support much of anything.

Diagnosed with Crohn's in 1979 after many failures at identifying the problem, I approached my gastroenterologist in the early 1980s with the revelation that I had experienced a flare three Novembers in succession. He remarked that getting ready for the holidays while chasing around a small child must have made me overly tired.

He also sent me to the National Library of Medicine near Washington, D.C., to research my disease. I had the distinct impression that as long as I kept my nose in those books, I would be out of his hair.

Through my volunteer work with Crohn's patients during the last 25 years, I know that many have complained about seasonal flares. Although a number of studies have attempted to substantiate what they report, the results have been disappointing, even in recent years.

The National Library of Medicine excerpted the results of a study in the March 2004 issue of Gastroenterology. This project utilized data collected between 1988 and 1997 for 1,587 patients with Crohn's disease as well as 2,773 suffering from ulcerative colitis (UC). Although researchers noted a slight increase in UC activity in the spring, they concluded that in general, the data did not suggest a relationship between seasons and flares in disease activity.

A study reported in The American Journal of Gastroenterology collected data from endoscopies conducted at 73 sites throughout the United States. Researchers noted that between January 2000 and December 2003, the number of colonoscopies performed increased by more than fourfold. However, the proportion of procedures associated with a Crohn's diagnosis dropped by 28 percent. The proportion of those linked to a UC diagnosis fell by half. The study concluded that activity of either disease was not shaped by any obvious seasonal variation.

The journal Digestion reported results of a study of hospital treatment for IBD in Italy. The conclusion published in early 2006 was that for the most serious flares - those resulting in routine hospital treatment - there was no seasonal pattern, regardless of the patient's age or sex or the location of the disease.

By contrast, another Italian study reported in Digestive and Liver Disease in 2006 offered a somewhat anemic conclusion that the onset of Crohn's symptoms occurred more frequently during the spring-summer season than during other parts of the year. It followed earlier studies reporting variations in the onset of symptoms in UC but not Crohn's patients.

The study followed just 425 IBD patients. For 353 of them, the researchers observed the onset of symptoms of disease activity. Of this 83 percent, 150 suffered from Crohn's, while the remaining 203 were UC patients.

So, what's a body to believe? The one glaring fact about Crohn's disease is that it's a very humbling condition for medical professionals to treat and study. There are far more unknown facts about it than those that have already been identified and catalogued.

I have met dozens of patients who are adamant that their disease goes berserk nearly every March or April no matter which standard IBD medications are part of their regimen. And for every one who reports spring disease activity, I find one like myself who tends to flare in November.

In general, physicians are very reluctant to prescribe higher-octane meds than those a patient normally takes just to ward off a flare that might or might not happen. However, there are several things a patient can do as the seasons begin to change:

Check your pattern. If you can't recall a seasonal flare in past years, consult your calendar. It's very important to keep a diary or calendar where you record all disease activity and changes in diet and medication. Should you suspect seasonal flares but can't find them in your records, ask your doctor's staff to check your chart. If you've been there five years in a row in late March with a complaint, you probably have seasonal flares.

Consider your allergies. One of the more popular theories of the cause of Crohn's activity has to do with allergic reactions. Many patients report other allergies to substances such as dust, mold and spring pollens in addition to having other autoimmune diseases such as lupus. My gastroenterologist recommends a prescription antihistamine for at least the season in question; I take it 365 days a year.

Prepare for the battle. Start getting an extra half hour or so of sleep each day. Make sure your home is well stocked with battle rations such as soups, canned bottles of nutritional supplements, bottled water, gelatin and other easy-on-the-gut foods. Double-check that you have plenty of all your medications. Clear your calendar of unnecessary appointments. Don't schedule major travel if you sense a flare is on its way.

Document, then document more. Write a minimum of one paragraph each day to note symptoms, happy times and hours living in the bathroom. Try to gauge disease activity. Did your joints ache on Monday? Did you have a fever or Tuesday? What were you able to eat on Friday? If keeping a journal or diary sounds overwhelming, you can jot all of this information on a calendar with large spaces for each day of the week.

Believe what you see. Just because a zillion studies report that there probably is no basis for concluding Crohn's flares can be seasonal doesn't mean this is true. You know what you're experiencing. Taking into account advice from your physician, act on it.

Sources:
The National Library of Medicine article
The American Journal of Gastroenterology report
Digestive and Liver Disease article