Mental health interventions have been found to have a positive impact on the symptoms of inflammatory bowel disease

A recent meta-analysis conducted by researchers at New King’s College in London suggests that interventions for mental health could help alleviate symptoms associated with inflammatory bowel disease (IBD). The researchers analyzed biomarkers linked to IBD to arrive at their conclusion. According to their findings, psychological therapy was highly effective at reducing IBD symptoms, more so than antidepressants and exercise which also showed some improvement. By tracking levels of two biomarkers commonly associated with IBD inflammation: calprotectin and C-reactive protein (CRP), the researchers were able to determine the efficacy of the interventions in reducing IBD symptoms. The study analyzed data from 28 controlled trials involving 1,789 participants, and incorporated biomarker data wherever possible.

The study reinforces the existing knowledge of the brain-gut axis that links mental health to the development and behavior of 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 inflammation associated with IBD. The study’s first author, Natasha Seaton, a PhD student at King’s College, cited several statistics from a 2021 study to confirm the connection between IBD and mental health.

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 nerveTrusted Source 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
Studies have shown that psychological interventions are more effective than antidepressants in alleviating the symptoms of Inflammatory Bowel Disease (IBD).

“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.

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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 used fecal calprotectin and CRP, two biomarkers of IBD, to make 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 stated that fecal calprotectin tests are valuable indicators of whether treatment for IBD is effective or not.

“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 that they often refer IBD patients for psychological counseling in his practice.
“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
IBS is often confused with IBD, inflammatory bowel disease, 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.

Inflammatory Bowel Disease (IBD) refers to a group of three bowel conditions that cause inflammation. These conditions include Crohn’s disease, which affects any part of the digestive tract from the mouth to the anus, Ulcerative colitis, which affects the large intestine, and Indeterminate colitis inflammatory bowel disease, which shares characteristics of both Crohn’s disease and ulcerative colitis.

There is evidence to suggest that Crohn’s disease may be hereditary because it often occurs in multiple members of the same family. It also tends to occur more frequently in the Jewish population compared to other populations.

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