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DJG and ACF are joint last authors.
Significance of this study
What is already known on this subject?
Symptoms of common mental disorders affect more than one-third of patients with IBD in remission.
Adverse disease outcomes may be more common in patients with IBD with underlying symptoms of anxiety and depression.
Therefore, the brain–gut axis may have bidirectional effects in IBD, but previous studies have been underpowered and demonstrate conflicting results.
What are the new findings?
We performed a systematic review and meta-analysis to assess the effect of symptoms of common mental disorders on future adverse outcomes in patients with IBD (including flare, escalation of therapy, hospitalisation, emergency department attendance, surgery or a composite of any of these) and the effect of active disease on future development of common mental disorders.
Symptoms of anxiety at baseline were significantly associated with future risk of escalation of therapy hospitalisation, emergency department attendance or a composite of any adverse outcome.
Symptoms of depression at baseline were significantly associated with future risk of flare, escalation of therapy, hospitalisation, emergency department attendance, surgery or a composite of any adverse outcome.
Clinically active disease at baseline was associated with future development of symptoms of anxiety or depression.
Significance of this study
How might it impact on clinical practice in the foreseeable future?
The brain–gut axis has a bidirectional influence on the prognosis of IBD and the development of new symptoms of common mental disorders.
Patients with symptoms of active disease or symptoms of anxiety and depression should be offered psychological support alongside specialist IBD management.
Further longitudinal research assessing the trajectory of symptoms of anxiety and depression, and their impact on IBD activity, is required to help better select cohorts of patients to be involved in trials of gut–brain neuromodulators or psychological therapies.
Introduction
Inflammatory bowel disease (IBD) is a chronic disorder of the gastrointestinal (GI) tract that encompasses both Crohn’s disease (CD) and ulcerative colitis (UC), with increasing prevalence across Europe and North America.1 The natural history of IBD fluctuates through periods of relapse and remission, with management strategies focused on immunosuppressive medications and surgery. The pathophysiology is incompletely understood, but felt to be influenced by environmental and genetic factors, combined with immunological dysregulation and alteration of the...