- What is a flare up?
- How do I manage a flare up?
- What to do in an emergency?
- Is Azathioprine a form of immunosuppression medication?
- I have been started on Azathioprine/6-Mercaptopurine; do I need a blood test?
- Can I have the flu and pneumococcal vaccination?
- Can I have a live vaccination whilst taking immunosuppression medication?
- I have been advised I may need ‘biologic’ therapy; do you have any information on this?
- Can I take Anti-inflammatory medications such as; Ibuprofen, Diclofenac or Aspirin?
- Do you have a patient panel?
∎ What is a flare up?
This is when symptoms of your Crohn’s disease or Ulcerative Colitis return. These may include;
- Going to the toilet more than usual for you
- Loose poo or diarrhoea with any blood or mucus for more than 3 days
- Abdominal pain
- Waking up through the night to go to the toilet
- General feeling of unwell or fever
You may also experience other symptoms such as;
- Mouth Ulcers
- Swelling or painful eyes
- Skin rashes
- Joint pains or swelling
- Fatigue
∎ How do I manage a flare up?
∎ Ulcerative Colitis
If you have signs of a flare up and are taking 5-ASA medication, it is safe to double your daily dose for 6 weeks. 5-ASA medications have different brand names, please see below for guidance:
- Asacol: from 2.4g to 4.8g per day
- Mezavant: from 2.4g to 4.8g per day
- Octasa: from 2.4g to 4.8g per day
- Pentasa: from 2g to 4g per day
- Salofalk: from 1.5g to 3g per day
Even if your symptoms settle quickly, continue taking the higher dose for 6 weeks then reduce back to the lower dose.
If you have known kidney problems please do not increase your medication without seeking advice first.
If you are prescribed suppositories or enemas and you have a supply of these at home, start these as well as increasing your 5-ASA tablets. It is safe to take them every night to control your symptoms.
If you do not see an improvement to your symptoms please contact the IBD helpline 01932 722244 (helpline open Mon, Weds, and Friday 9-12).
∎ Crohn’s disease
Please contact the IBD helpline via telephone 01932 722244 (helpline open Mon, Weds, and Friday 9-12), your query will be responded to within 72 working hours.
∎ Investigations
Please call the IBD helpline 01932 722244 (helpline open Mon, Weds, and Friday 9-12) or your GP to request the following stool and blood samples. These tests can be extremely helpful in aiding your IBD team (who can interpret the results) to decide on the best treatment for you.
2 stool samples – one to check for Bacteria/cultures – the other to check for Faecal Calprotectin.
Having IBD means you are more at risk of developing infections in your gut. A stool sample can help decide whether you need Antibiotic therapy, in some cases there may be other causes of a change in you bowel habit other than IBD.
Calprotectin is a protein that is released in your gut when you have a relapse.
Routine blood test - Full Blood, Count, Liver Function tests, Urea and Electrolytes and CRP inflammatory marker
These blood tests can be extremely useful in determining whether your IBD has begun to relapse.
Blood tests can be booked online, or can be booked at your GP surgery.
∎ Steroids
Prednisolone / Budesonide / Beclomethasone - read more.
Please do not start taking steroids unless advised by your GP or IBD Nurse. It is important to remember that these medicines are not recommended as a long term treatment and in many cases are only needed when IBD symptoms will not respond to increasing your current therapy. Please let your IBD Specialist Team know if you are prescribed these. The current medical treatments for both Crohn’s disease and Ulcerative Colitis are designed to spare you from systemic steroids like Prednisolone and their potential side effects.
Budesonide and Beclomethasone are steroids which do not carry such a high risk of side effects.
∎ What to do in an emergency?
If the problem is urgent, or the IBD helpline is unavailable, patients should contact their GP/ out-of-hours service, ring 111 or go to the NHS England website.
Some signs could include:
- Stoma blockage: not passing wind or poo or passing watery poo, nausea, bloating or swelling tummy, tummy cramps, swollen stoma, nausea/vomiting or both.
- Severe dehydration, malnourishment and vomiting.
- Severe tummy pain, a high temperature and a rapid heartbeat.
- All medicines have a small risk of side effects, such as chest pain, rapid heartbeat or hives. If you experience any side effects that you are worried about while taking your medicine, contact your IBD team or your GP as soon as possible.
∎ Is Azathioprine a form of immunosuppression medication?
Yes or you may have been started on an alternative immunosuppression medication named 6-Mercaptopurine. You should have been fully counselled about this medication.
Please contact your IBD Team if you need further information or see the Azathioprine medication leaflet from Crohn’s and Colitis UK.
∎ I have been started on Azathioprine / 6-Mercaptopurine; do I need a blood test?
A routine blood test is required every week for the first 6 weeks, then at week 10 when we may adjust your dose. You must call the IBD helpline the day after each blood test to review your results (01932 722244) (helpline open Mon, Weds and Friday 9-1).
∎ Can I have the flu and pneumococcal vaccination?
All patients with inflammatory bowel disease should have the annual flu vaccination, and 3-5 yearly pneumococcal vaccination as available.
∎ Can I have a live vaccination whilst taking immunosuppression medication?
No. It is unsafe for you to have live vaccinations whilst taking the following medication;
- Azathioprine / 6-Mercaptopurine
- Methotrexate
- Prednisolone >20mg dosage
- Infliximab
- Adalimumab
- Vedolizumab
- Tofacitinib
- Golimumab
- Ustekinumab
∎ I have been advised I may need ‘biologic’ therapy; do you have any information on this?
Crohn’s and Colitis UK website have some useful leaflets explaining these medications;
You will also be fully counselled by your IBD Team before starting this medication.
∎ Can I take Anti-inflammatory medications such as; Ibuprofen, Diclofenac or Aspirin?
You should avoid taking these medications and discuss with your IBD Team if these are required for another illness. Where possible you could try paracetamol or codeine instead.
∎ Do you have a patient panel?
Unfortunately at this moment in time, we do not. Going forwards, this may be something we may look into to support the development of the IBD service at ASPH.
