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Q. What does stress have to do with Crohn's disease?

Answered by
Dr. Vadivel Kumaran S
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 04, 2018

Hello doctor,

I have Crohn's disease. Two years back, I was fine. I had gone through extreme stress early that year and after that, I had a flare-up. I lost 9 kg in a month. Then, the doctors detected ulcers in my ileum I was diagnosed with Crohn's. I was out of work for 14 months. Assuming that it is a genetic or immune system-related disease, I have a couple of questions.

  1. Does it initiate due to stress?
  2. Does Crohn's get worse due to stress because now I need to take Humira every alternate week?
  3. Does the ulcers/flare-up happen due to stress?

I am currently on Humira (Adalimumab), Azathioprine, and Omeprazole.

Dr. Vadivel Kumaran S

General Medicine Internal Medicine Medical Gastroenterology


Welcome to

You have a very good treatment response to Adalimumab. You are on top-down therapy. Usually, flares are due to non-compliance with medications, secondary infections or malignant transformation. Usually, stress does not cause flare-ups.

You may be switched back to Pentasa granules (Mesalazine) and Azoran (Azathioprine) as your terminal ileum has normalized endoscopically. You need to comply with medications.

For more information consult a medical gastroenterologist online -->

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Thank you doctor,

My medicine is working perfectly. I never had a flare up/stomach pain since five months. I am normal at present and I gained 17 kg. But that is not my question. My question is different. I wanted to know what caused that flare up. In every article on the internet, I saw that Crohn's is caused by genetic, immune system problem or environmental issue but stress can cause a flare-up. In many cases, patients, when diagnosed with Crohn's disease, were extremely stressed. So, I wanted to know the reason.

I was fine just two years back. Two years back something happened and I had an emotional breakdown. I was not sleeping and crying most of the day. And then I started having loose motion and vomiting. I could not eat food and my health suddenly deteriorated and I lost more than 9 kg in a month. So, earlier I was thinking that it was caused by the stress. But after research, I understood that stress is not the main cause of the disease but stress can cause a flare-up or worsen the existing condition.

So, I am emailing you all my reports and want to know what caused that flare up. I was out of work for about 14 months for that flare up (six months at home). I had extreme joint pain and I could not walk for two weeks. I had a severe deficiency of vitamin D and B12 and my doctors here told that I could have permanent damage to my nervous system.

So, I wanted to know the reason for that extreme flare up. I could not visit a doctor to know the reason because it will be expensive. That is why I am asking you.

  1. Does it initiate due to stress?
  2. Does Crohn's get worse due to stress because now I need to take Humira every alternate week? If I stop Humira for a week, then I start having lose motion. So, does stress worsen the disease?
  3. Does the ulcers/flare-up happen due to stress?
  4. Why that flare up happened when I was extremely stressed? Is there no relation?

Dr. Vadivel Kumaran S

General Medicine Internal Medicine Medical Gastroenterology


Welcome back to

I think I have already answered your question on stress as a cause for Crohn's or flare. Yet again, stress is not an inciting factor to cause Crohn's disease. Stress does not cause flares in CD. Usually when flares occur people are stressed. A physician's role is to work up for what caused the flare, to look for any treatable cause.

And the disease course is a waxing and waning phenomenon depending on your balance between the inflammatory mediators and anti-inflammatory mediators. Medications do the balancing act.

For more information consult a medical gastroenterologist online -->

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