The bidirectional risk of inflammatory bowel disease and anxiety or depression: A systematic review and meta-analysis

Comprehensive Management of Ulcerative Colitis and its Associated Intra-Extra Intestinal Complications with a Multifunctional Inulin Hydrogel Complex

Excessive accumulation of reactive oxygen species (ROS) and dysbiosis of gut microbiota are pivotal etiological factors in the pathogenesis of ulcerative colitis (UC) and its associated intestinal and extraintestinal manifestations (e.g., intestinal microthrombosis, anxiety, and depression symptoms). This investigation presents a multifunctional inulin complex (PB/NKase@Inulin gel) incorporating Prussian blue nanozymes (PB NZs) and the thrombolytic agent nattokinase (NKase) for the therapeutic management of dextran sulfate sodium (DSS)-induced UC and its associated intestinal and extraintestinal complications. Following oral administration, the PB/NKase@Inulin gel, characterized by prolonged retention of PB NZs and NKase at inflamed colonic sites, can facilitate continuously ROS scavenging, attenuate oxidative stress damage, effectively reduce pro-inflammatory cytokine levels. Importantly, PB/NKase@Inulin gel can not only robustly inhibit inflammatory microthrombosis formation but also effectively lyses thrombi due to the potent thrombolytic properties of NKase both in vitro and in vivo. Furthermore, the PB/NKase@Inulin gel is able to modulate gut microbiota homeostasis and alleviate multiple stresses responses (including anxiety and depression) in a UC mouse model via microbiota-gut-brain (MGB) axis interactions. Overall, the PB/NKase@Inulin gel offers an innovative paradigm for comprehensive therapeutic interventions in DSS-induced UC and its multifaceted complications.

Psychological interventions for treatment of inflammatory bowel disease

BACKGROUND

Persons with inflammatory bowel disease (IBD) have an increased risk of suffering from psychological problems. The association is assumed to be bi-directional. Psychological treatment is expected to improve quality of life (QoL), psychological issues and, possibly, disease activity. Many trials have tested various psychotherapy approaches, often in combination with educational modules or relaxation techniques, with inconsistent results.

OBJECTIVES

To assess the effects of psychological interventions on quality of life, emotional state and disease activity in persons of any age with IBD.

SEARCH METHODS

We searched Web of Science Core Collection, KCI-Korean Journal Database, Russian Science Citation Index, MEDLINE, Psyndex, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, and LILACS from inception to May 2023. We also searched trial registries and major gastroenterological and selected other IBD-related conferences from 2019 until 2023.

SELECTION CRITERIA

Randomized controlled trials of psychological interventions in children or adults with IBD compared to no therapy, sham (i.e. simulated intervention), or other active treatment, with a minimum follow-up time of two months, were eligible for inclusion, irrespective of publication status and language of publication. Interventions included psychotherapy and other non-pharmacological interventions addressing cognitive or emotional processing, patient education, or relaxation techniques to improve individual health status.

DATA COLLECTION AND ANALYSIS

Two raters independently extracted data and assessed the study quality using the Risk of Bias 2 Tool. Pooled standardized mean differences (SMD) for continuous outcomes and relative risks (RR) for event data were calculated with 95% confidence intervals (CI), based on separate random-effects models by age group, type of therapy and type of control. An SMD of 0.2 was considered a minimally relevant difference. SMD ≥ 0.4 was considered a moderate effect. Group analyses were planned to examine differential effects by type of IBD, disease activity, psychological comorbidity, therapy subtype, and treatment intensity. Statistical heterogeneity was determined by calculating the I2 statistic. Publication bias was assessed by presenting a funnel plot and calculating the Eggers Test. GRADE Profiling was used to describe the certainty of the evidence for relevant results.

MAIN RESULTS

Sixty-eight studies were eligible. Of these, 48 had results reported in sufficient detail for inclusion in the meta-analyses (6111 adults, 294 children and adolescents). Two trials were excluded from the meta-analysis following sensitivity analysis and tests for asymmetry because of implausible results. Most studies used multimodular approaches. The risk of bias was moderate for most outcomes, and high for some. The most common problems in individual trials were the inability to blind participants and investigators and outcome measures susceptible to measurement bias. The main issues leading to downgrading of the certainty of the evidence were heterogeneity of results, low precision and high or moderate risk of bias in the included trials. Publication bias could not be shown for any of the inspected analyses. In adults, psychotherapy was slightly more effective than care-as-usual (CAU) in improving short-term QoL (SMD 0.23, 95% CI 0.12 to 0.34; I2 = 13%; 20 trials, 1572 participants; moderate-certainty), depression (SMD -0.27, 95% CI -0.39 to -0.16; I2 = 0%; 16 trials, 1232 participants; moderate-certainty), and anxiety (SMD -0.29, 95% CI -0.40 to -0.17; I2 = 1%; 15 studies, 1135 participants; moderate-certainty). The results for disease activity were not pooled due to high heterogeneity (I2 = 72%). Interventions which used patient education may also have small positive short-term effects on QoL (SMD 0.19, 95% CI 0.06 to 0.32; I2 = 11%; 12 trials, 1058 participants; moderate-certainty), depression (SMD -0.22, 95% CI -0.37 to -0.07; I2 = 11%; 7 studies, 765 participants; moderate-certainty) and anxiety (SMD -0.16, 95% CI -0.32 to 0.00; I2 = 10%; 6 studies, 668 participants; moderate-certainty). We did not find an effect of education on disease activity (SMD -0.09, 95% CI -0.28 to 0.10; I2 = 38%; 7 studies, 755 participants; low-certainty). Pooled results on the effects of relaxation techniques showed small effects on QoL (SMD 0.25, 95% CI 0.08 to 0.41; I2 = 30%; 12 studies, 916 participants; moderate-certainty), depression (SMD -0.18, 95% CI -0.35 to -0.02; I2 = 0%; 7 studies, 576 participants; moderate-certainty), and anxiety (SMD -0.26, 95% CI -0.43 to -0.09; I2 = 13%; 8 studies, 627 participants; moderate-certainty). Results for disease activity were not pooled due to high heterogeneity (I2 = 72%). In children and adolescents, multimodular psychotherapy increased quality of life (SMD 0.54, 95% CI 0.06 to 1.02; I2 = 19%; 3 studies, 91 participants; moderate-certainty). The results for anxiety were inconclusive (SMD -0.09; 95% CI 0.-64 to 0.46; 2 trials, 51 patients, very low-certainty). Pooled effects were not calculated for depressive symptoms. Disease activity was not assessed in any of the trials compared to CAU. In education, based on one study, there might be a positive effect of the intervention on quality of life (MD 7.1, 95% CI 2.18 to 12.02; 40 patients; low-certainty evidence) but possibly not on depression (MD -6, 95% CI -12.01 to 0.01; 41 patients; very low-certainty). Anxiety and disease activity were not assessed for this comparison. Regarding the effects of relaxation techniques on children and adolescents, all results were inconclusive (very low-certainty).

AUTHORS' CONCLUSIONS

Psychological interventions in adults are likely to improve the quality of life, depression and anxiety slightly. Psychotherapy is probably also effective for improving the quality of life in children and adolescents. The evidence suggests that psychological interventions may have little to no effect on disease activity. The interpretation of these results presents a challenge due to the clinical heterogeneity of the included trials, particularly concerning the type and various components of the common multimodular interventions. This complexity underscores the need for further research and exploration in this area.

Association between adverse childhood experiences and gastro-esophageal diseases later in life: A large-population cohort and Mendelian randomization study

BACKGROUND

Adverse childhood experiences (ACEs) are widely recognized as associated with stress-associated digestive disorders, yet their comprehensive relationship with gastro-esophageal diseases as well as the potential mechanisms of depression remains underexplored.

METHODS

The prospective study included 133,638 participants aged 40-69 from UK Biobank with full information on ACEs, depression, and gastro-esophageal diseases. ACEs were retrospectively measured both as individual types (physical, emotional, and sexual abuse, and physical and emotional neglect) and cumulative scores of experienced types. Cox proportional hazards model was utilized to assess the association of ACEs with the overall and type-specific risks of diseases. Two-sample Mendelian randomization (TSMR) was conducted utilizing data from a genome-wide association study of ACEs (N = 185,414) to further examine the causal relationship. Mediation analysis was performed to quantify the role of depression.

RESULTS

During a median follow-up of 13.3 years, those who had a history of ACEs were observed with a 15 % higher overall risk of gastro-esophageal diseases (HR, 1.15; 95%CI, 1.12-1.19) and 10-25 % increased type-specific risks compared to unexposed participants. Among five individual types of ACEs, the association was more prominent for emotional abuse (1.22, 1.17-1.27) and sexual abuse (1.24, 1.18-1.30). TSMR analysis consistently reported positive associations between ACE and four subtypes of gastro-esophageal diseases. Depression was found to mediate 17.2 % (13.5 %, 24.0 %) of the aforementioned relationship.

CONCLUSIONS

Our findings highlight the importance of early screening and intervention on ACEs to reduce the long-term risk of gastro-esophageal diseases, and stress the potential of depression as a ponderable indirect intervention target.

Mental Health Disorders in Patients with Inflammatory Bowel Disease Onset in Childhood or Youth - A Nationwide Cohort Study from Denmark

Purpose

The study aims to explore the association between patients diagnosed with inflammatory bowel disease (IBD) in childhood or youth and mental health disorders.

Methods

The study is a register-based cohort study of patients with IBD-onset before 25 years of age and matched references. They were followed until 30 years of age. The incidence rate and incidence rate ratio (IRR) for a wide spectrum of mental health disorders were assessed based on diagnostic codes from the Danish National Patient Registry, reimbursed prescriptions for psychotropic medications, and composite measures combining diagnosis and medication. Furthermore, the relative excess risk due to interaction (RERI) for parental educational level and parental mental health disorders were estimated.

Results

A total of 4904 patients with Crohn's disease (CD), 5794 with ulcerative colitis (UC), and 94,802 matched references were identified. Patients with CD-onset before age 18 had a higher risk of anxiety disorders (IRR 1.58 (CI95%: 1.33-1.86)), while patients with CD-onset between age 18 to 24 had a higher risk of both anxiety and mood disorders. Patients with UC-onset before age 18 had a higher risk of anxiety disorders (IRR: 1.39 (CI95%: 1.19-1.64)). In general, patients with IBD had a higher risk of receiving psychotropic medication. Parental education had a subadditive interaction with the risk of emotional disorders for both patients with CD and UC, while maternal mental health disorders had a subadditive interaction for patients with UC.

Conclusion

Patients with CD and UC have a higher risk of mental health disorders, primarily due to an elevated risk of emotional disorders and a higher use of psychotropic medication. Surprisingly, the study demonstrated subadditive effect of parental education and for patients with UC maternal mental health disorders on the risk of emotional disorders.

Evaluating large language models as patient education tools for inflammatory bowel disease: A comparative study

BACKGROUND

Inflammatory bowel disease (IBD) is a global health burden that affects millions of individuals worldwide, necessitating extensive patient education. Large language models (LLMs) hold promise for addressing patient information needs. However, LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.

AIM

To assess the utility of three LLMs (ChatGPT-4.0, Claude-3-Opus, and Gemini-1.5-Pro) as a reference point for patients with IBD.

METHODS

In this comparative study, two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns. These questions were used to evaluate the performance of the three LLMs. The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy, comprehensibility, and correlation. Simultaneously, three patients were invited to evaluate the comprehensibility of their answers. Finally, a readability assessment was performed.

RESULTS

Overall, each of the LLMs achieved satisfactory levels of accuracy, comprehensibility, and completeness when answering IBD-related questions, although their performance varies. All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods. Nevertheless, when dealing with more complex medical advice, such as medication side effects, dietary adjustments, and complication risks, the quality of answers was inconsistent between the LLMs. Notably, Claude-3-Opus generated answers with better readability than the other two models.

CONCLUSION

LLMs have the potential as educational tools for patients with IBD; however, there are discrepancies between the models. Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.

Burden of Common Mental Disorders in Ulcerative Colitis and Irritable Bowel Syndrome Patients: An Analysis of Risk Factors

Background: Common mental disorders are an underdiagnosed comorbidity, which can significantly worsen the prognosis of the main disease and decrease the quality of life. We aimed to investigate the prevalence of depression and anxiety in a cohort of irritable bowel syndrome with diarrhea (IBS-D) and ulcerative colitis (UC) patients and to evaluate the risk factors for their occurrence. Materials and Methods: A total of 112 patients were evaluated. Multivariable analysis was used to determine associations between patient factors and common mental disorders, evaluated with PHQ-9 and GAD-7 questionnaires. Results: We found a significantly higher prevalence of moderate and severe anxiety among patients with IBS-D, when compared with the UC group (p < 0.01). Linear regression analysis revealed an inverse association between anti-TNF-alpha monoclonal antibodies treatment and a higher PHQ-9 score (p = 0.02). Multivariate analysis revealed that, in patients with UC, the presence of children has been associated with a higher GAD-7 score (p = 0.01), both individually and in combination with a higher duration of the disease. (p < 0.01). For IBS-D, a combination of active employment status and religious belief, active employment status and higher educational level, as well as religious belief and the presence of children correlated with higher GAD-7 scores (p = 0.03, p = 0.03 and p = 0.02, respectively). Conclusions: Infliximab used in the treatment for UC improved the parameters of depression. Patients with UC who have university education and a longer duration of the disease are at increased risk of developing depression and anxiety, especially if they have children in care. Regarding IBS-D patients who have an active work status, religious beliefs and caregivers are at increased risk of developing anxiety.

Anthropometric Trajectories in Children Prior to Development of Inflammatory Bowel Disease

Importance

Poor nutrition and growth in childhood have short-term and long-term consequences, so understanding the timing of the onset of an impaired nutritional status is crucial for diagnosing and treating inflammatory bowel disease (IBD) at its earliest stage.

Objective

To assess anthropometric trajectories before a pediatric diagnosis of IBD and growth recovery after diagnosis.

Design, Setting, and Participants

This population-based cohort study included children born in Denmark from January 1, 1997, through December 31, 2015, with weight and length or height measurements at birth and at least 1 length or height and weight measurement at school age based on the Danish Medical Birth Register and the Danish National Child Health Register. Within this population, all individuals diagnosed with IBD at ages 5 to 17 years, according to the Danish National Patient Register, were identified. Data were analyzed from October 13, 2023, to April 17, 2024.

Exposure

A pediatric diagnosis of IBD compared with the corresponding population without the disease.

Main Outcomes and Measures

The outcome measures were z scores for length or height, weight, and body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) before and after pediatric IBD diagnosis compared with reference and sibling populations.

Results

The final study population included 916 133 individuals (51.2% male) with a median of 3 pairs of length or height and weight measurements collected (IQR, 2-6 pairs). Of those, 1522 (median age, 14.3 years [IQR, 11.8-16.3 years]; 763 female [50.1%]) were diagnosed with IBD (851 [55.9%] with Crohn disease [CD] and 671 [44.1%] with ulcerative colitis [UC]). Compared with children without IBD, individuals with a later diagnosis of CD had declining anthropometric measures 3 years (weight: mean, -0.12 g [95% CI, -0.20 to -0.03 g]; BMI: mean, -0.13 [95% CI, -0.21 to -0.04]) and 1 year (length or height: mean, -0.20 cm [95% CI, -0.29 to -0.10 cm]) prior to diagnosis, whereas this was observed 1 year prior to a diagnosis of UC for weight (mean, -0.12 g [95% CI, -0.22 to -0.02 g]) and BMI (mean, -0.13 [95% CI, -0.23 to -0.03]). Deviating anthropometric patterns persisted after diagnosis, with the slowest recovery observed in children with CD.

Conclusions and Relevance

The findings of this large-scale population-based cohort study of anthropometrics in children suggest impaired nutritional status as assessed by weight up to 3 years and by length or height 1 year before a diagnosis of CD and by weight up to 1 year before a diagnosis of UC. These findings emphasize that the onset of pediatric IBD may occur years prior to diagnosis, that growth recovery may first occur after diagnosis and treatment, and that frequent nutritional screenings may help ensure a healthy transition to adulthood.

Adjunct Therapies to Standard Care for IBS and IBD Patients: Digestive Symptoms Improvement and Quality of Life Optimization

Background: The prevalence of both inflammatory bowel diseases (IBD) and Irritable Bowel Syndrome (IBS) is increasing, with persistent digestive symptoms, an altered quality of life, and higher rates of anxiety, chronic fatigue, and sleep trouble than the general population. Methods: This scoping review will analyze the latest clinical practice recommendations and clinical studies on non-pharmaceutical interventions such as diet adaptations, physical activity, cognitive behavioral therapies, and medical nutrition therapies such as probiotics, soluble fibers, chitin-glucan, and micronutrients for digestive symptoms relief, quality of life improvement and nutritional deficiencies correction in IBS and IBD patients. The objective is to help healthcare practitioners and dietitians to build personalized care program for IBD and IBS patients. Results: Mediterranean diet, physical activity, cognitive behavioral therapies and medical nutrition therapies such as selected probiotics, soluble fibers, chitin glucan, peppermint oil and micronutrients are effective as adjunct therapies. Conclusions: These adjunct therapies may help to reduce persistent digestive symptoms, correct nutritional deficiencies and improve quality of life of IBS and IBD patients.

Association of Poor Sleep Quality With Adverse Outcomes in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

OBJECTIVES

Inflammatory bowel disease (IBD) is a group of chronic diseases with adverse events such as disease flare, progression, drug escalation, hospitalization, and surgery. Meanwhile, patients with IBD often have sleep disorders. We performed this systematic review and meta-analysis aiming to investigate the relationship between sleep quality of patients with IBD and their prognosis.

METHODS

MEDLINE and Web of Science Core Collection databases were searched for articles published up to November 2024. We pooled the hazard ratio (HR) and odds ratio (OR) with the corresponding 95% confidence interval (CI) for adverse outcome events during the follow-up period in patients with poor sleep quality at baseline compared with those with normal sleep quality.

RESULTS

Five studies were included with a total of 2333 patients with IBD. Poor sleep quality in patients with IBD was significantly correlated with the occurrence of adverse outcome events at follow-up (OR 1.63, 95% CI 1.14-2.33). Patients with Crohn's disease (CD) with poor sleep quality had a significantly higher risk of adverse outcome events at follow-up (OR 1.58, 95% CI 1.26-1.99), whereas those with ulcerative colitis (UC) did not (OR 1.10, 95% CI 0.76-1.60).

CONCLUSION

Early identification of poor sleep quality in patients with IBD, especially CD, has a predictive effect on their prognosis.

The impact of anxiety and depression on quality of life in a cohort of inflammatory bowel disease patients from Northeastern of Brazil

OBJECTIVE

This study aims to assess whether the association between chronic pathologies and depressive and/or anxious disorders is high, resulting in a reduction in the patient's quality of life.

PATIENTS AND METHODS

This is a prospective cross-sectional study with a descriptive and analytical design. Sociodemographic data and lifestyle habits were collected. Subsequently, the Inflammatory Bowel Disease Questionnaire (IBDQ) and the Hospital Anxiety and Depression Scale (HADS) were applied.

RESULTS

A total of 141 patients participated in the study, with a mean age of 45.78 (SD 16.01) years, of which 60.3% were female (n=85) and 39.7% were male (n=56). 58.9% had ulcerative colitis (UC) (n=83), and 41.1% had Crohn's disease (CD) (n=58). 16.5% of patients had a previous diagnosis of generalized anxiety disorder (GAD) and/or major depression (MD) (n=23). Regarding IBDQ scores, participants with anxiety had significantly lower mean scores in all IBDQ items (p<0.001), while the depression diagnosis obtained significantly lower mean values for systemic (p=0.015), emotional (p=0.001), and intestinal symptoms (p=0.005).

CONCLUSION

The results indicate that anxiety and depression negatively impact the quality of life of patients with IBD independently of the disease activity.

The Burden of Psychiatric Manifestations in Inflammatory Bowel Diseases: A Systematic Review With Meta-analysis

BACKGROUND

Psychiatric disorders in patients with inflammatory bowel disease (IBD) represent a significant but uncertain facet of the disease, with unsolved questions regarding their overall magnitude, their impact on intestinal disease, and the whole burden of psychiatric manifestations.

AIM

This systematic review summarizes the evidence on the prevalence and impact of psychiatric disorders, including depression, anxiety, bipolar disorder (BD), and schizophrenia, among patients with IBD.

METHODS

A systematic search across PubMed/MEDLINE, Embase, and Scopus databases from January 2010 to January 2023 was performed to identify relevant studies. The focus was on studies exploring the prevalence of specific psychiatric disorders in IBD patients compared to the general population and that reported specific outcome measures. A subsequent meta-analysis (MA) assessed the strength of the association between IBD and these psychiatric disorders, with data reliability ensured through rigorous extraction and quality assessment.

RESULTS

Out of 3,209 articles, 193 met the inclusion criteria and only 26 provided complete data for comprehensive analysis. These studies showed a significantly higher overall prevalence of psychiatric comorbidities in IBD patients compared to the general population. The MA showed a significant association between IBD and depression (pooled OR 1.42, 95% CI = 1.33-1.52, P < .0001) and anxiety (pooled OR 1.3, 95% CI = 1.22-1.44, P < .0001). The association between IBD and BD was significant (pooled OR 1.64, 95% CI = 1.20-2.24, P < .0001) but showed considerable heterogeneity (I2 = 94.01%). Only 3 studies examined the association between schizophrenia and IBD, providing widely heterogeneous results, with an inconclusive OR, estimated at 0.93 (95% CI = 0.62-1.39, P = .73).

CONCLUSIONS

This MA highlights the high prevalence of psychiatric disorders, particularly depression and anxiety, in IBD patients, which exceeds rates in the general population. BD in IBD is proving to be an important but under-researched area. The sparse and contradictory data on schizophrenia requires further investigation. These findings highlight the need for better understanding, early detection, and tailored mental health interventions in the management of IBD to significantly improve patients' quality of life.

Systematic review and meta-analysis: Impact of depression on prognosis in inflammatory bowel disease

BACKGROUND AND AIM

Depression is highly prevalent in patients with inflammatory bowel disease (IBD), which may affect the prognosis of IBD. This aimed to investigate the impact of depression on prognosis in IBD.

METHODS

A systematic literature search was performed in four databases (Medline, Embase, Web of Science, and PsycINFO) up to December 31, 2023. Studies were included if they investigated the impact of depression on prognosis in IBD. The primary outcome was flare in IBD, and secondary outcomes were hospitalization, readmission, emergency visits, surgery, and escalation of medical therapy. Relative risks (RRs) were utilized to estimate the risk in each of the above prognostic indicators.

RESULTS

Fourteen cohort and 10 case-control studies matched our entry criteria, comprising 630 408 patients with IBD. Twenty-two of included studies were considered to have a low risk of bias. Depression was found to significantly increase the risk of flare (RR = 1.37, 95% CI 1.16-1.63), hospitalization (RR = 1.11, 95% CI 1.00-1.23), readmission (RR = 1.32, 95% CI 1.04-1.67), emergency visits (RR = 1.33, 95% CI 1.12-1.59), surgery (1.38, 95% CI 1.08-1.76), and escalation of medical therapy (RR = 1.38, 95% CI 1.13-1.69) in IBD. Of note, patients with depression in ulcerative colitis had significant differences in readmission (RR = 1.38, 95% CI 1.19-1.60) and escalation of medical therapy (RR = 1.78, 95% CI 1.55-2.04). Additionally, the association was observed in patients with Crohn's disease in terms of flare (RR = 1.47, 95% CI 1.08-2.01) and hospitalization (RR = 1.20, 95% CI 1.03-1.40).

CONCLUSIONS

Current evidence suggested that depression could significantly increase the risk of poor prognosis worsening in patients with IBD. However, the association varied in IBD subtypes.

The Role of Environmental and Nutritional Factors in the Development of Inflammatory Bowel Diseases: A Case-Control Study

BACKGROUND

The incidence and prevalence of inflammatory bowel diseases (IBD) are increasing around the world, especially in Western countries. The objective of this study was to evaluate the health habits of healthy controls and individuals with IBDs to identify possible risk factors for IBD development.

METHODS

A case-control study was conducted among Spanish participants over 18 years of age. A self-administered questionnaire was completed by subjects to collect information on several sociodemographic variables and habits, such as the consumption of tobacco, alcohol, antibiotics, nonsteroidal anti-inflammatory agents and macronutrients; anxiety and depression; and quality of life.

RESULTS

The main risk factors identified were age; living in an urban environment; anxiety; and excessive consumption of proteins, carbohydrates and fats. In addition, the consumption of fibre had a preventive effect against IBD development.

CONCLUSIONS

Age, anxiety and living in urban areas pose a risk of suffering from IBD, as does the excessive consumption of certain macronutrients. However, the consumption of fibre has a protective effect on the development of some IBD types.

Associations between immune biomarkers and symptoms of anxiety, depression, and insomnia in paediatric inflammatory bowel disease: A preliminary longitudinal analysis

Innate immunity may influence the onset of affective symptoms and alter sleep patterns in chronic inflammatory conditions. Here, we tested the prospective associations between baseline serum C-reactive protein (CRP), albumin, and CRP/albumin ratio (CAR, i.e., an emerging biomarker of disease activity), and self-reported symptoms of anxiety, depression, and insomnia at 1-year follow up in paediatric inflammatory bowel disease (n = 17). After controlling for baseline values, CAR (ρ = 0.591, p = 0.026) predicted anxiety symptoms, while albumin predicted both anxiety (ρ = -0.687, p = 0.007) and insomnia symptoms (ρ = -0.648, p = 0.012). Current findings preliminarily suggest that inflammation may influence anxiety and sleep disturbance in paediatric IBD.

Latent profiles of fatigue in inflammatory bowel disease

INTRODUCTION

Fatigue is prevalent in people with inflammatory bowel disease (IBD) and has been associated with IBD activity, sleep quality, depression, and anxiety. This study aimed to identify fatigue profiles or clusters through latent profile analysis.

METHODS

An online questionnaire was administered through three tertiary IBD centres, social media and through Crohn's Colitis Australia. Fatigue was assessed via the Functional assessment of chronic illness measurement system fatigue subscale (FACIT-F), a validated assessment of fatigue and its severity. Validated measures of anxiety, depression, IBD activity and sleep quality were also included. Latent profile analysis was performed including fatigue, sleep quality, active IBD, and depression and anxiety. The relationships between profiles and IBD and demographic data were investigated.

RESULTS

In a cohort of 535 respondents, 77% were female, the median age was 41 years (range 32-52 years), and the majority had Crohn's disease (62%). Severe fatigue was seen in 62%. Latent profile analysis identified four distinct profiles differing by fatigue score - low fatigue, at-risk profile, active IBD, and a poor mental health profile. Female gender, obesity and opioid usage were associated with higher risk of being in the active IBD and poor mental health profile. Age over 40 was associated with lower risk of being in the poor mental health profile.

CONCLUSION

Latent profile analysis identifies four classes of fatigue in an IBD cohort with associations with specific risk factors for fatigue along with specific IBD and demographic attributes. This has implications for the classification of fatigue in IBD and treatment algorithms.

Risk of Anxiety, Depression, and Attention-Deficit/Hyperactivity Disorder in Pediatric Patients With Inflammatory Bowel Disease: A Population-Based Cohort Study

INTRODUCTION

Inflammatory bowel disease (IBD) is associated with depression and anxiety in adults, but data are scarce on risk of psychiatric diseases in children with IBD. We aimed to estimate the risk of anxiety, depression, or attention-deficit/hyperactivity disorder (ADHD) in patients with pediatric-onset IBD.

METHODS

We performed a nationwide, register-based cohort study including all patients with pediatric-onset IBD diagnosed in Denmark during 1998-2018, resulting in 3,559 patients matched 1:5 on age, sex, municipality of residence, and time period, resulting in 17,795 reference individuals. We used Cox regression to calculate hazard ratios for each outcome after a diagnosis with IBD.

RESULTS

Patients with pediatric-onset IBD had an increased risk of depression (hazard ratio [HR] 1.50; 95% confidence interval [CI] 1.26-1.80) and of using antidepressants (HR, 1.54; 95% CI, 1.39-1.71) and, surprisingly, a reduced risk of using methylphenidate (HR, 0.75; 95% CI, 0.58-0.98). Patients with both IBD subtypes (Crohn's disease and ulcerative colitis) had an increased risk of using antidepressants and developing depression, which was particularly high in patients with Crohn's disease (HR, 1.73; 95% CI, 1.35-2.22). Patients with ulcerative colitis had reduced risk of using methylphenidate (HR, 0.63; 95% CI, 0.43-0.93) and a reduced-although not statistically significant-risk of being diagnosed with ADHD compared with the background population.

DISCUSSION

Patients with pediatric-onset IBD have a 50% increased risk of developing depression, which is important for healthcare providers to be aware of and manage. Remarkably, we found a reduced risk of receiving methylphenidate and being diagnosed with ADHD, which merits further investigation.

Association of dietary intake of live microbes with bowel health and depression in US adults: a cross-sectional study of NHANES 2005-2010

BACKGROUND

Depression substantially impacts on quality of life, personal relationships, and self-care. Gastrointestinal disorders are the common comorbidity of depression and 24.3% of patients with depression have disordered bowel habits. Dietary intake of live microbes alters the host's microflora and is beneficial for the prevention and control of bowel health and depression. We aim to investigate the association of dietary intake of live microbes with bowel health and depression and to further examine weather bowel health or depression mediates the therapeutic effect of live microbes.

METHODS

Participants' data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2005-2010, which is designed to examine the health and nutritional status of the non-institutionalized US population by a complex, multi-stage, probability sampling design. The foods were grouped into categories on the basis of estimated microbial levels: low (<104 CFUs/g), medium (Med; 104-107 CFU/g), and high (Hi; >107 CFU/g). Participants were further classified into three groups (G1: participants without MedHi foods intakes; G2: those with MedHi foods intakes greater than zero but less than the median; and G3: those with MedHi foods intakes greater than the median).

RESULTS

A total of 10,785 US adults were selected. The median of MedHi foods intake was 66.1 g/day. Participants in the G2 (OR = 0.739, 95% CI: 0.581-0.941) and G3 (OR = 0.716, 95% CI: 0.585-0.877) groups had significant association with lower risks of depression, and participants in the G3 group had significant association with lower risks of hard stools (OR = 0.885, 95% CI: 0.692-0.989) and loose stools (OR = 0.769, 95% CI: 0.585-0.954). Interestingly, further mediation analyses showed that the association of dietary live microbe intake with depression is mediated by the stool types, and the association of dietary live microbe intake with stool types is mediated by the depression (all P < 0.05).

CONCLUSIONS

A high dietary intake of live microbes, especially a minimum of 66.1 g of MedHi foods per day, is associated with a lower risk of depression, hard stools, and loose stools consistency. Depression and bowel health mutually act as mediators in this association, indicating dietary intake of live microbes may simultaneously affect bowel health and depression.

Disruption of the microbiota-gut-brain axis is a defining characteristic of the α-Gal A (-/0) mouse model of Fabry disease

Fabry disease (FD) is an X-linked metabolic disease caused by a deficiency in α-galactosidase A (α-Gal A) activity. This causes accumulation of glycosphingolipids, especially globotriaosylceramide (Gb3), in different cells and organs. Neuropathic pain and gastrointestinal (GI) symptoms, such as abdominal pain, nausea, diarrhea, constipation, and early satiety, are the most frequent symptoms reported by FD patients and severely affect their quality of life. It is generally accepted that Gb3 and lyso-Gb3 are involved in the symptoms; nevertheless, the origin of these symptoms is complex and multifactorial, and the exact mechanisms of pathogenesis are still poorly understood. Here, we used a murine model of FD, the male α-Gal A (-/0) mouse, to characterize functionality, behavior, and microbiota in an attempt to elucidate the microbiota-gut-brain axis at three different ages. We provided evidence of a diarrhea-like phenotype and visceral hypersensitivity in our FD model together with reduced locomotor activity and anxiety-like behavior. We also showed for the first time that symptomology was associated with early compositional and functional dysbiosis of the gut microbiota, paralleled by alterations in fecal short-chain fatty acid levels, which partly persisted with advancing age. Interestingly, most of the dysbiotic features suggested a disruption of gut homeostasis, possibly contributing to accelerated intestinal transit, visceral hypersensitivity, and impaired communication along the gut-brain axis.

The Effect of Serotonin Transmission on Depressive and Insomnia Symptoms in Inflammatory Bowel Diseases

The serotonergic pathway may impact the pathogenesis and the course of inflammatory bowel diseases (IBDs). The aim of this study was to investigate the relationship between 5-HT, the serotonin transporter (SERT), and the clinical course of the disease with the occurrence of sleep and mood disorders. Participants completed sleep questionnaires and the Beck Depression Inventory (BDI). Serum 5-HT, SERT protein expression, and mRNA levels were quantified. Additionally, patients treated with anti-TNF therapy were examined before and after treatment. In this study, 77 patients with IBD and 41 healthy controls (HCs) were enrolled and 24 of them were treated with anti-TNF therapy. Patients with IBD had higher 5-HT levels and SERT protein expression than the HCs, but not mRNA SERT levels (p = 0.015, p = 0.001, p = 0.069, respectively). Similar results were obtained for patients in the active state of the disease compared to the non-active state. There was a positive relationship between insomnia severity and SERT protein expression. BDI did not correlate with serotonin or SERT. After anti-TNF therapy, only 5-HT levels were decreased. 5-HT and SERT protein are overexpressed in active IBD and may represent a candidate for novel disease activity biomarkers. The correlation between the SERT protein level and the severity of insomnia symptoms might be among the underlying biochemical factors of sleep disturbances. Anti-TNF treatment might contribute to the reduction in 5-HT levels.