title: Gut-brain actions underlying comorbid anxiety and depression associated with inflammatory bowel disease.
abstract: IntroductionInflammatory bowel disease (IBD) is a chronic relapsing and remitting disorder characterised by inflammation of the gastrointestinal tract. There is a growing consensus that IBD is associated with anxiety- and depression-related symptoms. Psychological symptoms appear to be more prevalent during active disease states with no difference in prevalence between Crohn's disease and ulcerative colitis. Behavioural disturbances including anxiety- and depression-like symptoms have also been observed in animal models of IBD.
  
  
  RESULTS
  The likely mechanisms underlying the association are discussed with particular reference to communication between the gut and brain. The close bidirectional relationship known as the gut-brain axis includes neural, hormonal and immune communication links. Evidence is provided for a number of interacting factors including activation of the inflammatory response system in the brain, the hypothalamic-pituitary-adrenal axis, and brain areas implicated in altered behaviours, changes in blood brain barrier integrity, and an emerging role for gut microbiota and response to probiotics in IBD.DiscussionThe impact of psychological stress in models of IBD remains somewhat conflicted, however, it is weighted in favour of stress or early stressful life events as risk factors in the development of IBD, stress-induced exacerbation of inflammation and relapse.
  
  
  CONCLUSIONS
  It is recommended that patients with IBD be screened for psychological disturbance and treated accordingly as intervention can improve quality of life and may reduce relapse rates.
authors.affiliation: 1Neuropsychopharmacology Research Group,Trinity College Institute of Neuroscience,Trinity College,Dublin,Ireland.
authors.forename: Áine
authors.initials: Á
authors.lastname: Abautret-Daly
authors.affiliation: 1Neuropsychopharmacology Research Group,Trinity College Institute of Neuroscience,Trinity College,Dublin,Ireland.
authors.forename: Elaine
authors.initials: E
authors.lastname: Dempsey
authors.affiliation: 3Department of Gastroenterology,Hospital Central de Asturias,Oviedo,Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Parra-Blanco
authors.affiliation: 3Department of Gastroenterology,Hospital Central de Asturias,Oviedo,Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Medina
authors.affiliation: 1Neuropsychopharmacology Research Group,Trinity College Institute of Neuroscience,Trinity College,Dublin,Ireland.
authors.forename: Andrew
authors.initials: A
authors.lastname: Harkin
mesh_terms: D000818:Animals; D001921:Brain / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D000069196:Gastrointestinal Microbiome / Q000276:immunology*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D007249:Inflammation / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D015212:Inflammatory Bowel Diseases / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D013315:Stress, Psychological / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology
keywords: anxiety; colitis; depression; gut–brain axis; inflammatory bowel disease