Finding the causes of the inflammatory bowel diseases (IBD, Crohn’s disease, ulcerative colitis, and indeterminate colitis) has been difficult for researchers to untangle. It’s thought that IBD may be a result of a genetic predisposition and an environmental trigger, with microbiome and immune system changes as a chaser. (Rudbaek)

Unwinding the Causes

What this means is that people with IBD may have certain genes associated with the disease. This is the result of many studies done on people with IBD and their family members, and looking closely at their DNA. More than 200 genes have been identified that may be a part of the development of a form of IBD. (Rudbaek)

But that’s not the end of the story. There’s also an environmental component. There’s something that we are exposed to that “switches on” the genes, causing people to develop IBD. In fact, there may be many different types of triggers, and more than one could be interacting together to alter all the bugs in our digestive system and cause the immune system to react inappropriately.

This makes sense when thinking about family patterns of IBD, because most people diagnosed with IBD don’t have a family member with the disease. And when people do have a family history of IBD, it doesn’t always follow any kind of a recognizable pattern (such as parent to child, although this does happen).

On top of not understanding all the causes, we also don’t have a good handle on what leads to flare-ups. People with IBD have periods of less and more active disease. Sometimes it may seem like there’s a clear cause. But other times it seems like there’s no good reason to explain why the disease comes and goes.

We can’t do anything about our genes. That leaves us looking at the potential triggers for IBD and IBD flare-ups that could possibly lead to treatments or even prevention.

Can We Blame the Weather?

I was diagnosed with ulcerative colitis as a teenager, in the fall of my junior year of high school. After that, year after year, I would experience a flare-up in the fall, and sometimes again in the spring. There didn’t seem to be any help for it: in those days, there were not many treatments and there were no biomarker tests (such as fecal calprotectin).

It wasn’t until I entered into my career in medical writing that I saw that this wasn’t only a problem for me. Other people experienced flare-ups in a seasonal pattern.

Some of research shows that the seasons or the weather might not have an effect on how many people have a flare-up of IBD that lands them in the hospital. (Soncini, Manser) Other studies show that temperature changes could lead to flare-ups. (Lee) What’s more, it could not only be just the weather, but may be connected to air pollution and/or changes in the microbiome that occur with temperature fluctuations.

A meta-analysis that looked at 20 studies included those that looked at the effects of temperature, weather, season, and atmosphere on IBD. The authors found that 3 studies showed a connection between higher air pollution rates and exacerbation of IBD. Taking all the studies included into account, flare-ups of IBD were slightly more common in warmer weather. (Moon)

However, the authors also noted that there were some limitations to this study, including that all the studies didn’t report on the same type of data, making them difficult to compare to one another. They also point out that culture and habits (things like diet, hygiene, holidays) weren’t taken into account in these studies. (Moon)

Now think of me and my fall flare-ups. What happens in the fall in the Midwest in North America? People go back to school, which of course is associated with a certain amount of stress. It’s possible that stress, lack of sleep, a change in temperature, a lower vitamin D level, and other things we haven’t even looked into yet, all came together in a perfect storm to send me into the hospital.

Of course, the authors of all these studies call for more research. And in my head I can hear the voice of one of my mentors, who taught me not to end an article with “more research is needed,” because that’s the conclusion of every piece of research ever done. But in this case, I think it’s worth saying, because even a meta-analysis only included 20 studies on this topic (done over the course of 30 years!), demonstrating that it’s an under-researched area.

Where Does This Leave Us?

We still aren’t able to get out ahead of knowing when someone is going to have a flare-up of their IBD with any type of certainty. But we do know some of the things that could play into it. For that reason, it’s worth reiterating the ways we need to care for our health in order to do our best to prevent a flare.

This can include:

• Getting enough quality sleep
• Lowering stress levels when possible
• Participating in any preferred self-care modalities (talk therapy, mindfulness, meditation, yoga, or other adjunctive therapies)
• Seeing a gastroenterologist for monitoring on a regular basis (this can include blood tests, fecal calprotectin levels, and endoscopy or other procedures to look at the gut)
• Staying hydrated (preferably with water)
• Taking IBD medication on time
• Working with a dietitian to develop a nutritious diet (which is needed when in remission and when in a flare-up)

Much has been written about how to avoid flare-ups, most of which include the ideas I’ve listed above as well as many others. The evidence behind them varies, however.

The best advice is going to be to pay attention to your own body. When something seems off, it’s worth getting checked out as soon as possible. Some people can tell when a flare-up is coming on: there may be looser stools or some abdominal pain, even mouth ulcers or other extra-intestinal problems like joint pains or skin rashes.

For others, and this was the case for me, the symptoms of a flare-up came on fast and furious. After a few years of flaring up in the September/October time range, I put it together that this was a problematic time for me. However, there wasn’t a lot I could do about it other than to try to protect my health and to be vigilant for any changes.

Keeping good records of diet and symptoms can help, as well as talking with your healthcare providers about what might cause a flare-up. We can look at the research all day, but the best resource is going to be your own intuition coupled with the experience of your gastroenterology team. Every case of IBD is different, which means that as the patient or the care partner: you are the expert in your or your loved one’s IBD. Being vigilant about symptoms and getting in to see your health care team as soon as possible when symptoms occur are the best tools to catch a flare-up early and get it treated.

Sorry I don’t have better news or advice than that. We need more research. 🙂

Sources:

Rudbaek JJ, Agrawal M, Torres J, Mehandru S, Colombel JF, Jess T. Deciphering the different phases of preclinical inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2024;21:86-100. doi:10.1038/s41575-023-00854-4.

Soncini M, Triossi O, Leo P, et al. Seasonal patterns of hospital treatment for inflammatory bowel disease in Italy. Digestion. 2006;73:1-8. doi:10.1159/000090036.

Manser CN, Kraus A, Frei T, Rogler G, Held L. The Impact of Cold Spells on the Incidence of Infectious Gastroenteritis and Relapse Rates of Inflammatory Bowel Disease: A Retrospective Controlled Observational Study. Inflamm Intest Dis. 2017;2:124-130. doi:10.1159/000477807.

Lee YC, Kim TJ, Kim JH, et al. Short-term effects of ambient temperature on acute exacerbation of inflammatory bowel disease: A nationwide case-crossover study with external validation. PLoS One. 2023;18:e0291713. doi:10.1371/journal.pone.0291713.

Moon SJ, Lee YC, Kim TJ, Kim K, Son HJ. Effects of temperature, weather, seasons, atmosphere, and climate on the exacerbation of inflammatory bowel diseases: A systematic review and meta-analysis. PLoS One. 2022;17(12):e0279277. doi:10.1371/journal.pone.0279277.