New research suggests that mental health interventions like therapy may help improve symptoms of inflammatory bowel disease.
- A new meta-analysis suggests
that mental health interventions may improve symptoms associated with
inflammatory bowel disease (IBD).
- The researchers tracked
biomarkers of IBD to reach their conclusion.
- The findings show
psychological therapy was highly effective at reducing IBD symptoms.
A new meta-analysis —
study of studies — from New King’s College in London reinforces existing
knowledge of the brain-gut axis that links mental health to the development and
behavior of inflammatory
bowel disease (IBD).
The findings show that
improving depression and anxiety symptoms in people with IBD reduces the
severity of the condition by statistically significant amounts.
Mental health therapy interventions, in particular,
were most successful at alleviating the inflammation associated with IBD.
Antidepressants and
exercise also resulted in improvements, though smaller.
Rather than relying on
self-reporting of IBD symptoms, the researchers tracked levels of two
biomarkers commonly associated with IBD inflammation: calprotectin and
C-reactive protein (CRP).
After searching five
medical databases for relevant studies, the authors of the study analyzed data
from 28 random, controlled trials involving 1,789 participants. Where biomarker
data existed, it was incorporated in the study’s analysis.
The study is published
in eBioMedicine.
What’s
the link between IBD and mental health?
The new study builds on
existing evidence establishing a confirm the connection between IBD and mental health.
The study’s first
author, PhD student Natasha Seaton, a PhD student at King’s College, cited several
statistics from a 2021 study:
“Depression
and anxiety are common in people with IBD. 25% percent of people with IBD have
clinical levels of depression, 32% have clinical levels of anxiety. These rates
rise to 39% and 58%, respectively, when disease is active and inflammation
levels are higher.”
“If you take a snapshot of IBD patients at one time
period, it seems as though some inflammatory markers are associated with
anxiety [or] depression symptoms,” Seaton told Medical News Today.
Dr.
Tine Jess of the Center For Molecular Prediction Of Inflammatory Bowel
Disease, told MNT: “There are several mechanistic links between mental health
and intestinal inflammation, including vagal
nerve signaling, systemic inflammatory markers and the gut
microbiome.” Dr. Jess was not involved with the present study.
Dr. Rudolph Bedford, a gastroenterologist with Saint John’s
Physician Partners in Santa Monica, CA, not involved with the research, said
that a poor psychological state can increase pro-inflammatory cytokines.
“We also see this with gut
dysbiosis, or bacterial overgrowth,” Dr. Bedford told MNT.
“These things change the
signaling of the brain, and also of the potential inflammatory cytokines.
[With] inflammatory bowel disease, it goes back and forth between the two,” he
added.
Therapy
highly effective in reducing IBD symptoms
Psychological
interventions outperformed antidepressants in improving IBD symptoms.
“We know that the brain
can regulate some of the activity of the immune system and of our gut, so an
improvement in mood may be linked to brain activity which could reduce
inflammation,” Seaton explained.
Better mental health is
known to strengthen one’s immune system, she said, noting that people with IBD
become “able to manage their physical health better, for example, more physical
exercise, better diet, improved sleep quality, [and
they are] more likely to take prescribed medication.”
“Psychological therapies may equip people with
skills — e.g., CBT techniques, mindfulness
practices, stress management
strategies — that would empower them to manage their IBD better, leading
to improved physical health,” Seaton noted.
Tracking
biomarkers of IBD
The researchers of the
present study tracked fecal calprotectin and CRP, two biomarkers of IBD, to
draw their conclusions.
“Fecal calprotectin and
CRP are used as measures of intestinal and systemic inflammation, and hence
reflect disease activity in patients with IBD,” Dr. Jess explained.
Both biomarkers can help physicians objectively
determine whether a person with IBD is experiencing a flareup or if they are
currently in remission, Seaton said.
Bedford added they are
valuable indicators that a patient’s treatment for IBD is or isn’t working.
“If you have a normal
calprotectin, then you pretty much know there’s no inflammation in the colon,
the same thing goes for the CRP — if it’s normal, then you know your treatment
is working,” he said.
Leveraging
the gut-brain axis
“This systematic review
and meta-analysis shows that psychological interventions which address mood
outcomes have a beneficial effect on both intestinal and systemic inflammation,
which I think may still come as a surprise to many people,” Dr. Jess noted.
Dr. Bedford pointed out
that, “Not everybody with mood swings,
depression, or anxiety develops inflammatory bowel disease. The same thing goes
the other way — not everybody with inflammatory bowel disease has depression or
anxiety,” he said.
Dr. Bedford said in his
practice they often refer IBD patients for psychological counseling.
“We find that their
inflammatory bowel disease improves when their anxiety and their depression
improves or is mitigated in some way,” he said.
What
to know about inflammatory bowel syndrome
IBD is often confused
with IBS, irritable bowel syndrome, but IBS does not involve inflammation.
“IBD is an
inflammatory, autoimmune
condition, whereby debilitating symptoms — pain, fatigue, incontinence,
diarrhea — are caused by inflammation in the gastrointestinal tract,” Seaton
explained.
IBD is the collective
name given to three inflammatory bowel conditions:
- Crohn’s disease,
which affects any part of the gastrointestinal tract from the mouth all
the way to the anus.
- Ulcerative
colitis, which affects any area in the large intestine.
- Indeterminate colitis inflammatory
bowel disease, which contains features of both Crohn’s disease and
ulcerative colitis.
There is some indication
that Crohn’s is hereditary since
it tends to be experienced by multiple family members, and disproportionately
strikes the Jewish population.
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