🩺 General MedicineGastrointestinalStudentInternResident

Inflammatory Bowel Disease — Acute Flare

Also known as: IBD flare · ulcerative colitis flare · Crohn's flare · acute severe colitis

An acute worsening of ulcerative colitis or Crohn's disease — bloody diarrhoea, abdominal pain, urgency and systemic upset. Acute severe ulcerative colitis is a medical emergency.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

People with known or new IBD; flares are triggered by infection, NSAIDs, stopping medication, and (in UC) recent smoking cessation.

Red flags — escalate / refer

Acute severe colitis (≥6 bloody stools/day with fever, tachycardia, anaemia or raised inflammatory markers), abdominal distension/toxic megacolon, or peritonism → admit; exclude C. difficile and CMV.

Work-up / diagnosis

1Bloods (FBC, CRP, U&E, albumin) and stool tests to EXCLUDE infection, including C. difficile.
2Abdominal X-ray for toxic megacolon in severe colitis; endoscopy to define extent/severity when appropriate; grade severity (e.g., Truelove & Witts for UC).

Management — overview

Acute severe UC → admit, IV corticosteroids, VTE prophylaxis and fluids; if no response by around day 3, give rescue therapy (ciclosporin or infliximab) and consider colectomy if medical therapy fails.
Milder flares → step up aminosalicylates and/or corticosteroids.
Crohn's flare → corticosteroids to induce remission and optimise maintenance (immunomodulators/biologics).
Involve gastroenterology and surgery early.

In-depthFull dosing & advanced protocol

Drug dosing

Corticosteroids

Induce remission in a flare (NOT for maintenance)

Adult dose: IV in acute severe colitis; oral for moderate flares — per protocol
Route: IV / oral

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Aminosalicylates (± immunomodulator/biologic)

UC therapy and maintenance / step-up

Adult dose: Per protocol
Route: Oral / topical

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Exclude infection; the day-3 decision

Always exclude C. difficile and CMV before escalating immunosuppression.
In acute severe UC, a failure to respond by around day 3 triggers rescue therapy or colectomy.
Give VTE prophylaxis despite the bleeding, and remember steroids are for induction, not maintenance.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

HypertensionPersistently raised arterial pressure (≥140/90 mmHg) — a leading, modifiable cause of stroke, heart attack, heart failure and kidney disease.DengueAn Aedes-borne viral febrile illness. Most cases self-limit, but plasma leakage can cause severe dengue — early recognition of warning signs and careful fluid therapy save lives.MalariaA mosquito-borne protozoal (Plasmodium) febrile illness. In India P. vivax and P. falciparum predominate; prompt diagnosis and species-specific treatment prevent severe disease.

Loading…

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Corticosteroids

Aminosalicylates (± immunomodulator/biologic)

📈 Exclude infection; the day-3 decision

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Corticosteroids

Aminosalicylates (± immunomodulator/biologic)

📈 Exclude infection; the day-3 decision

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Exclude infection; the day-3 decision

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Exclude infection; the day-3 decision

References