Flares & ER
Being admitted to the hospital for a Crohn's flare can feel overwhelming, especially if it is your first time. You may not know what tests are coming, how long you will be there, or what the doctors are actually trying to accomplish. The good news is that inpatient Crohn's management follows a fairly predictable pattern. Understanding that pattern can take some of the fear out of the experience. Most hospital stays for Crohn's disease last between three and seven days, though complicated cases can run longer. Here is a realistic look at what happens from the moment you arrive to the day you go home.
Why You Were Admitted
Hospitalization usually happens when a Crohn's flare is too severe to manage at home with oral medications. The most common reasons include uncontrolled diarrhea with dehydration, significant rectal bleeding, high fevers suggesting infection or abscess, signs of bowel obstruction, or failure to respond to outpatient therapy [1]. Your medical team will want to determine the phenotype and severity of your flare, rule out complications, and get inflammation under control with intravenous medications that work faster and more reliably than anything you can take by mouth [2].
The first hours typically involve a lot of questions and a lot of blood draws. Expect a complete blood count, inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), a metabolic panel, and stool samples to test for infections such as Clostridioides difficile [1][3]. Your team needs to distinguish between a disease flare and an infection that mimics one, because the treatments are very different.
Tests and Imaging in the First 48 Hours
Once blood work is underway, imaging usually follows. A CT scan of the abdomen and pelvis, often with oral and IV contrast, is the most common first-line imaging study for hospitalized Crohn's patients. CT can quickly identify complications like abscesses, fistulas, and bowel obstruction that would change the treatment plan [4]. If your team needs a closer look at the intestinal lining, a flexible sigmoidoscopy or colonoscopy may be performed during your stay, though full colonoscopy is sometimes deferred if the bowel is too inflamed or if obstruction is a concern.
MRI enterography may be ordered in place of or alongside CT, particularly to evaluate the small bowel or to avoid repeated radiation exposure. Your gastroenterologist and radiologist will choose the study that gives the clearest picture of your specific situation [4]. These imaging results, combined with lab work, help your team build a treatment plan within the first day or two.
IV Steroids and Bowel Rest
The cornerstone of inpatient Crohn's flare management is intravenous corticosteroids. The standard regimen is methylprednisolone 60 mg per day or hydrocortisone 300 to 400 mg per day, delivered through your IV line [2][5]. There is no added benefit to higher doses. Your team will assess your response over three to five days using stool frequency, abdominal pain levels, CRP trends, and sometimes repeat imaging.
Bowel rest is another component you will likely encounter. In mild cases, this means a clear liquid diet. In more severe situations, you may be placed on nothing by mouth (NPO) and receive nutrition intravenously through total parenteral nutrition, or TPN [1][2]. The goal is to reduce the workload on your inflamed intestine while the steroids bring inflammation down. Early enteral feeding (nutrition delivered through the gut) is encouraged whenever possible, as current guidelines recognize that prolonged bowel rest can lead to muscle loss and delayed recovery [2]. Your care team will advance your diet as your symptoms allow.
What Happens If Steroids Are Not Enough
By day three to five, your team will have a good sense of whether IV steroids are working. A standardized daily assessment, tracking stool counts, pain, and inflammatory markers, helps predict which patients will respond and which will need a change in strategy [2]. If your CRP remains elevated and symptoms have not meaningfully improved, the conversation shifts to rescue therapy.
Infliximab (Remicade) is the most commonly used rescue biologic for hospitalized Crohn's patients who fail IV steroids. A 2024 study found that inpatient rescue infliximab was safe and effective, with only 8% of patients requiring surgery during their initial admission and medical complication rates remaining low [6]. Your team may also discuss other biologic or small-molecule options depending on your treatment history and disease phenotype. If you have penetrating disease with fistulas or abscesses, the likelihood of needing surgery is higher even with rescue therapy [6].
When Surgery Enters the Conversation
Surgery is not a failure of treatment. For some patients, it is the most direct path to feeling better. If medical therapy has not controlled your flare, or if imaging reveals a complication like a stricture, abscess that cannot be drained, or perforation, your gastroenterologist and a colorectal surgeon will discuss surgical options with you. In a recent randomized trial, patients with uncomplicated terminal ileal Crohn's disease who underwent early ileocecal resection had higher rates of steroid-free and biologic-free remission at 12 months than those treated with infliximab alone [7]. Surgery may involve removing a diseased segment of bowel, draining an abscess, or repairing a fistula.
Preparing for Discharge and Beyond
Before you leave, your inpatient team will transition you from IV to oral medications, typically an oral steroid taper combined with a plan to start or adjust maintenance therapy. You should expect clear instructions on your medication schedule, follow-up appointments with your gastroenterologist (usually within two to four weeks), and guidance on diet advancement at home.
If you are heading to the hospital, bring your Aidy data. Your symptom history helps the inpatient team understand your baseline and how this flare compares to previous ones. Having a record of your medications, symptom patterns, and past flare timelines gives your doctors context that speeds up decision-making and personalizes your care from the moment you arrive.
Sources:
Day-by-Day Management of the Inpatient With Moderate to Severe Inflammatory Bowel Disease - PMC
Inpatient Management of Inflammatory Bowel Disease-Related Complications - Clinical Gastroenterology and Hepatology
Crohn's Disease Diagnosis and Testing - Crohn's & Colitis Foundation
Crohn's Disease - Diagnosis, Evaluation and Treatment - RadiologyInfo.org
Appropriate Use and Complications of Corticosteroids in Inflammatory Bowel Disease - Clinical Gastroenterology and Hepatology
Safety and Efficacy of Inpatient Infliximab Rescue Therapy for Acute Crohn's Disease Flares - PubMed
Perspective: Making Treatment Decisions for Crohn's Disease in 2025 - PMC