Exploring the gut-brain axis in a large cohort of patients with irritable bowel syndrome: Is there a link between depression and intestinal and extra-intestinal symptoms?

Abstract

Objective: We aimed to determine the prevalence of intestinal and extra-intestinal symptoms according to depression severity in a large cohort of patients with irritable bowel syndrome (IBS).

Patients and methods: A consecutive series of patients with diagnosis of IBS according to Rome IV criteria undertaking a social-media based program (B15 program) were analyzed. The B15 program provides evidence-based dietary and non-pharmacological recommendations (i.e., mindfulness techniques and exercise) to improve gastrointestinal health. All patients completed the symptom-severity questionnaire (IBS-SSS) to determine severity of disease and the patient health questionnaire (PHQ9) to assess depressive symptoms. Patients' depression severity was stratified according to the PHQ9 score: none (0-4), mild (5-9), moderate (10-14), moderately severe (15-19), and severe (20-27). Demographics, IBS phenotype and prevalence of intestinal and extra-intestinal symptoms were compared among groups.

Results: A total of 15,675 patients with IBS were included; 895 (12.1%) with none, 5,709 (36.4%) with mild, 4,279 (27.3%) with moderate, 2,457 (15.7%) with moderately severe, and 1,335 (8.5%) with severe depression. Mean IBS-SSS score was significantly higher in patients with depressive symptoms (none 256.5 vs. severe 324.1, p<0.0001). IBS-M (mixed bowel habits alternating constipation and diarrhea) was more frequent in those with depression (p<0.0001). The presence of bloating, heartburn, dyspepsia, and belching were significantly more common in patients with higher levels of depression (p<0.0001). The prevalence and number of extra-intestinal symptoms were also associated with the severity of depression (p<0.0001).

Conclusions: The presence and severity of depression are strongly associated with the prevalence of intestinal and extra-intestinal symptoms in patients with IBS. Stratifying patients based on both their symptomatic and psychological profile could help targeting therapy.