Introduction

Individuals affected by anxiety and depression are more likely to be affected by gastrointestinal (GI)diseases. Understanding the mechanisms underlying the association between mental and GI diseases can have critical translational implications across different scenarios. In this study, we designed an observational trial to explore the association of anxiety and depression with gastrointestinal diseases in the context of behavioral traits and socioeconomic status.

Aims & Methods

We recruited patients undergoing screening GI endoscopy from September 22, 2022 in Renmin Hospital of Wuhan University, investigated their anxiety and depression level by questionnaires including Patient Health Questionaire-9 (PHQ-9) and Generalized Anxiety Disorder (GAD-7), and collect their baseline information, including behavioral traits, socioeconomic status, and H. pylori infection, etc. The including criteria included: 1) Patients who can read, understand and sign informed consent forms; 2) Patients who receive gastrointestinal endoscopy examinations; 3) Patients who can understand the study, and are willing and able to complete all the procedures with follow-up visits. The excluding criteria included: 1) Patients who have been diagnosed with gastrointestinal tumors before this endoscopy (esophagus, stomach: low grade neoplasia, high grade neoplasia, cancer; colorectal: high grade neoplasia, cancer); 2) Patients with other serious physical diseases (such as severe cardiovascular and cerebrovascular diseases, organ failure, etc.); 3) Patients who have had major stress incidents in the past two weeks; 4) People who are addicted to drugs, alcohol or drugs. After GI endoscopy, all the endoscopic diagnosis of patients were collected. Finally, patients with different levels of anxiety and depression were compared according to their endoscopic diagnosis with behavioral traits and socioeconomic status using chi-square test and t-student test.

Results

From September 22, 2022 to March 23, 2023, 4947 patients who met the including criteria were recruited in Renmin Hospital of Wuhan University with 156 patients excluded according to the excluding criteria. Finally, 4791 patients were included for analysis. 3109 patients received upper GI endoscopy while 1682 patients received lower GI endoscopy. Patients with depression disorder were associated with higher incidence of gastric polyp (18.88% vs. 23.58%; PHQ-9≤4 vs. 4＜PHQ-9≤9; p=0.030), colorectal polyp (52.78% vs. 65.79%; PHQ-9≤4 vs. 9＜PHQ-9; p=0.027) and a higher body mass index (23.03 vs. 23.85; PHQ-9≤4 vs. 9＜PHQ-9; p=0.009). Patients with anxiety disorder were associated with higher incidence of reflux esophagitis (16.20% vs. 27.78%; PHQ-9≤4 vs. 9＜PHQ-9; p=0.023). Patients who suffering from colorectal polyps tended to be male (52.79% vs. 42.69, p=0.000) with obesity (BMI 23.89 vs. 22.99, p=0.000). And a relatively lower income was also associated with higher incidence of colorectal polyps (p=0.032).

Conclusion

Individuals affected by anxiety and depression are more likely to be affected by GI diseases like reflux esophagitis and colorectal polyps. And different socioeconomic status can also devote to several GI disease like colorectal polyps. Even though current evidence was dependent on endoscopy diagnosis, it helps us to understand the interplay among psychiatric disorders, behavioral traits, socioeconomic status in GI disorders and to develop more efficient programs to reduce the risk of GI diseases.

References

1. Sung H, Ferlay J, Siegel R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 2021, 71(3): 209-249.
2. Uhlenhopp D J, Then E O, Sunkara T, et al. Epidemiology of esophageal cancer: update in global trends, etiology and risk factors. Clinical journal of gastroenterology, 2020, 13(6): 1010-1021.
3. Rawla P, Barsouk A. Epidemiology of gastric cancer: global trends, risk factors and prevention. Przeglad gastroenterologiczny, 2019, 14(1): 26.
4. Ford A C, Yuan Y, Moayyedi P. Helicobacter pylori eradication therapy to prevent gastric cancer: systematic review and meta-analysis. Gut, 2020, 69(12): 2113-2121.
5. Kuo Y C, Yu L Y, Wang H Y, et al. Effects of Helicobacter pylori infection in gastrointestinal tract malignant diseases: From the oral cavity to rectum. World Journal of Gastrointestinal Oncology, 2022, 14(1): 55.
6. Beydoun M A, Beydoun H A, Weiss J, et al. Helicobacter pylori, periodontal pathogens, and their interactive association with incident all-cause and Alzheimer's disease dementia in a large national survey. Molecular Psychiatry, 2020: 1-16.

Introduction

Inflammatory bowel diseases (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD), are chronic gastrointestinal disorders accompanied by psychiatric comorbidities, particularly anxiety and depression. The link between IBD and anxiety and depression remains unclear, but it appears that, among others, it may be explained by altered tryptophan metabolism. Tryptophan, an essential amino acid, is crucial for maintaining mental health and regulating mood through its metabolic processes. It serves as a precursor for several biologically significant compounds, including serotonin, melatonin, and kynurenine metabolites. The interplay between inflammation, tryptophan metabolism, and mental health in IBD remains insufficiently explored.

Aims & Methods

This study aimed to assess the association between metabolites of the tryptophan-kynurenine pathway and depressive symptoms in IBD regarding the disease activity and phenotype. A cohort of 214 patients with IBD (70 with CD and 144 with UC) was included. Disease activity was determined using the Mayo score for UC and SES-CD for CD. Peripheral blood samples were analyzed for selected biomarkers, including metabolites of tryptophan-kynurenine pathway as well as indicators of oxidative stress and inflammation. Depressive symptoms were evaluated using the Beck Depression Inventory (BDI). Statistical analyses included correlation and regression models to explore the relationship between biomarkers and BDI scores, adjusting for clinical and demographic covariates.

Results

The BDI score in the study group ranged from 0 to 52. 31 individuals met the criteria for depression by scoring over 10 points. 137 patients with active disease exhibited significantly higher levels of hsCRP and nitrotyrosine and lower kynurenic acid levels compared to 77 with inactive disease. Kynurenic acid levels were negatively correlated with BDI scores (r = -0.220, p = 0.042), suggesting an association between tryptophan metabolism and depressive symptoms. Additionally, CD patients showed higher serotonin and anthranilic acid levels compared to UC patients (16.67 ± 26.23 vs 6.29 ± 12.55 and 0.35 ± 0.26 vs 0.17 ± 0.17, respectively), though no significant differences in BDI scores were observed between the groups. Biological treatment was more frequent in the active disease group and associated with higher BDI scores, even after adjusting for covariates.

Table 1. Comparison of selected metabolite levels between individuals with active disease and with inactive disease

Conclusion

The study revealed significant differences in the tryptophan-kynurenine metabolic pathway among patients with inflammatory bowel disease, which vary based on disease activity. Additionally, variations in the concentrations of certain metabolites are correlated with the severity of depression.

References

1. Kuźnicki, P., Kempiński, R., & Neubauer, K. (2021). The emerging role of mood disorders in inflammatory bowel diseases. In Advances in Clinical and Experimental Medicine. https://doi.org/10.17219/ACEM/127676
2. Mikocka-Walus, A., Pittet, V., Rossel, J.-B., von Känel, R., Anderegg, C., Bauerfeind, P., Beglinger, C., Begré, S., Belli, D., Bengoa, J. M., Biedermann, L., Bigler, B., Binek, J., Blattmann, M., Boehm, S., Borovicka, J., Braegger, C. P., Brunner, N., Bühr, P., … Zimmermann, D. (2016). Symptoms of Depression and Anxiety Are Independently Associated With Clinical Recurrence of Inflammatory Bowel Disease. Clinical Gastroenterology and Hepatology, 14(6), 829-835.e1. https://doi.org/10.1016/j.cgh.2015.12.045
3. Brown, S. J., Huang, X.-F., & Newell, K. A. (2021). The kynurenine pathway in major depression: What we know and where to next. Neuroscience & Biobehavioral Reviews, 127, 917–927. https://doi.org/10.1016/j.neubiorev.2021.05.018
4. Correia, A. S., & Vale, N. (2022). Tryptophan Metabolism in Depression: A Narrative Review with a Focus on Serotonin and Kynurenine Pathways. International Journal of Molecular Sciences, 23(15), 8493. https://doi.org/10.3390/ijms23158493

Introduction

Celiac disease is an autoimmune disorder where the intake of gluten (a protein found in wheat, barley, and rye) causes damage to the small intestine and impairs nutrient absorption. Studies have shown that individuals with celiac disease have reduced quality of life and higher levels of anxiety and depression. However, this has not been studied in the general population, among individuals with newly discovered, untreated celiac disease.

Aims & Methods

The aim of this study was to investigate anxiety, depression, mental health, and subjective well-being in individuals with newly diagnosed and untreated celiac disease, compared with the general population. This study used data from the fourth Trøndelag health study (HUNT4), conducted between 2017 and 2019 with over 56,000 adult participants from 20 years of age. Previously undiagnosed celiac disease was identified among the participants by analyses of blood samples from all participants and confirmed with endoscopy and duodenal biopsies. The participants in HUNT4 also answered questionnaires measuring levels of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), mental distress using the Cohort of Norway Medical Health Index (Conor-MHI), and subjective well-being using a three-part questionnaire. Differences in mental health among individuals with newly diagnosed celiac disease and the remaining HUNT4 participants were compared.

Results

Celiac disease was diagnosed in 454 HUNT4 participants by March 2022. The celiac group had a lower median age (53 vs. 56 years) compared to the remaining HUNT4 population. The celiac group had significantly lower mean scores on the HADS anxiety subscale (4.0 vs. 4.4), depression subscale (2.8 vs. 3.3), and total scale (6.8 vs. 7.7) compared to the reference population. On the CONOR-MHI scale, the celiac disease group had a lower total mean score (1.4 vs. 1.5) with lower scores in the categories of "secure and calm", "irritable", "happy and optimistic", "sad/depressed", and "lonely" compared to the reference population. Finally, the celiac disease group had a lower mean score on the question “Do you feel mostly strong and clear, or tired and fatigued?” (3.3 vs. 3.4) and a higher mean score on the question “How is your health now?” (3.0 vs. 2.9) compared to the reference population. No significant difference was observed in the HADS or CONOR-MHI scores by Marsh grades at diagnosis among the celiac disease group.

Conclusion

The study suggests that individuals with undiagnosed celiac disease have lower levels of anxiety, depression, and mental distress compared to the general population, while also reporting slightly better subjective well-being. These findings contradict other studies on psychological health in celiac disease.

Disclosure

No con

Introduction

There is conflicting data on the risk factors linked to Gastroesophageal Reflux Disease (GERD) and Functional Dyspepsia (FD). Studies that explore the association between anxiety/depression and GERD phenotypes (Esophagitis/EE and Non-Erosive Reflux Disease/NERD), FD, and Rome-IV syndromes are scarce.

Aims & Methods

The aim was to evaluate the association between epidemiological factors and comorbidities with GERD phenotypes, FD, and Rome-IV syndromes, as well as the relationship of these processes with anxiety/depression.
338 participants were selected from 357 patients referred to three tertiary centers in Granada (Spain) for endoscopic assessment. A gastroenterologist individually interviewed each participant prior to the procedure and administered three validated questionnaires (GERD-Q, Rome-IV, and HADS) to detect the presence of GERD, FD, and anxiety/depression, respectively.

Results

45/338 patients were controls, 198/58.6% were classified as GERD, 81/24.0% EE (49/14.5% symptomatic, and 32/9.5% asymptomatic), 117/34.6% NERD, 176/52.1% FD (43/12.7% epigastric pain syndrome, 36/10.7% postprandial distress syndrome, and 97/28.7% overlapping syndrome). 81 patients were mixed GERD-FD. Multivariate analysis found significant independent associations: age in NERD and FD; sex in EE, asymptomatic EE and FD; body mass index in NERD and FD; alcohol in EE; anxiety/depression in FD; use of calcium channel antagonists in EE; and inhalers in FD. We compared controls vs different groups/subgroups finding significantly more anxiety in NERD, FD, all Rome-IV syndromes, and mixed GERD-FD; more depression in FD, overlapping syndrome, and mixed GERD-FD; and higher levels of anxiety+depression in NERD, FD, overlapping syndrome, and mixed GERD-FD.

Table: Multivariate analysis (logistic regression) of factors associated with different groups and subgroups of GERD and FD

Conclusion

The existence of shared demographic and psychopathological risk factors in Non-Erosive Reflux Disease (NERD) and Functional Dyspepsia (FD) implies that they could be part of the same pathophysiological spectrum. The prevalence of anxiety was higher in NERD, while anxiety and depression were more frequent in FD. These results suggest that psychological therapy could be a supportive strategy for both conditions.

Introduction

The bidirectional interplay of the brain-gut axis alongside manifestations of anxiety and depression has already been demonstrated. Despite this fact, routine mental health assessments and interventions are not well-established in the treatment of acute (AP) and chronic pancreatitis (CP), potentially worsening clinical outcomes. Our objective is to achieve a comprehensive understanding of the mind-body connection within the context of pancreatitis by assessing the prevalence of depression and anxiety in patients with AP and CP.

Aims & Methods

Our protocol was registered on PROSPERO (CRD42023481739). We conducted a systematic search on 10 November 2023 in three databases (MEDLINE, Embase, and CENTRAL) to identify studies reporting the occurrence of depressive and anxiety-related symptoms in pancreatitis. The pooled proportion rate with 95% confidence intervals (CI) was calculated using a random-effects model.

Results

The prevalence of depressive symptoms was 16% in AP (CI 0.06; 0.39), while it was 34% in CP (CI 0.27; 0.43). The prevalence of anxiety symptoms in AP and CP was 15% (CI 0.07; 0.32) and 35% (CI 0.26; 0.45), respectively.

Conclusion

Anxiety and depression are significantly more frequently observed among individuals with pancreatitis compared to the general population. These conditions occur twice as often in CP compared to AP. Thus, we underscore the significance of psychological interventions in this patient population.

Introduction

Different pathophysiological mechanisms are thought to play a role in functional dyspepsia (FD) subgroups defined by Rome IV criteria. However, many more studies are needed to determine whether a better separation of pathophysiological mechanisms, so a better therapy choice, can be obtained with the Rome IV subgrouping. This study aims to investigate the difference in psychopathological comorbidities between the FD subgroups defined by the Rome IV criteria. We hypothesized that anxiety and depression would be risk factors differently for each functional dyspepsia subgroup according to Roma IV criteria.

Aims & Methods

This is a cross-sectional observational study conducted at a tertiary gastroenterology center in Turkey between December 2022 and April 2023. Dyspeptic patients, aged over 18 years old referred for an upper gastrointestinal endoscopy were recruited. Participants were asked to fill out the Rome IV gastroduodenal questionnaire along with the Hospital Anxiety and Depression Scale. FD subgroups were defined using the Rome IV criteria. Hospital Anxiety and Depression Scale was used to assess the anxiety and depression of participants. All statistical analyses were conducted using SPSS version 23.0.The p-value of <0.05 was accepted as statistically significant.

Results

Of 424 dyspeptic participants, FD was identified in 117 (27.5%) patients. There were 66 (56.4%) PDS (postprandial distress syndrome), 21 (18%) EPS (epigastric pain syndrome), and 30 (25.6%) overlapping cases. Depression was detected in 35% of FD patients; in 37.9% of the PDS subgroup, 30% of the overlapping subgroup, and 33.3% of the EPS subgroup; There was no difference between the groups (p:0.622). Anxiety was detected in 29.9% of FD patients; in 39.4% of the PDS subgroup, 23.3% of the overlapping subgroup, and 9.5% of the EPS subgroup; detected more frequently in PDS subgroup than in EPS and overlapping subgroups (p:0.022) (Table 1). The frequency of anxiety was significantly higher in patients with postprandial fullness and early satiation symptoms according to those without symptoms (35.8% vs. 15.6%, p:0.035; 44.7% vs. 23.9% p:0.027, respectively).

Conclusion

PDS subgroup, postprandial fullness, and early satiety symptoms were more associated with anxiety, according to the EPS subgroup undd epigastric pain symptom. Evaluating this patient groups in this respect and providing the necessary support can accelerate the recovery process of the patient. It seems reasonable to assume that anxiolytic drugs are of benefit in especially the PDS subgroup. Further studies assessing psychological factors and treatment strategies for FD Rome IV subgroups are required to confirm the relationship of subgroups with depression and anxiety.

References

1. Wauters L, Dickman R, Drug V, Mulak A, Serra J, Enck P, et al. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia. United European Gastroenterol J. 2021 Apr;9(3):307-331. doi: 10.1002/ueg2.12061.
2. Esterita T, Dewi S, Suryatenggara FG, Glenardi G. Association of Functional Dyspepsia with Depression and Anxiety: A Systematic Review. J Gastrointestin Liver Dis, June 2021 Vol. 30 No 2: 259-266. doi: 10.15403/jgld-3325.
3. Van den Houte K, Carbone F, Goelen N, Schol J, Masuy I, Arts J, et al. Effects of Rome IV Definitions of Functional Dyspepsia Subgroups in Secondary Care. Clinical Gastroenterology and Hepatology 2021;19:1620–1626. doi: 10.1016/j.cgh.2020.06.043.
4. Carbone F, Vanuytsel T, and Tack J. Analysis of Postprandial Symptom Patterns in Subgroups of Patients With Rome III or Rome IV Functional Dyspepsia. Clinical Gastroenterology and Hepatology 2020;18:838–846. doi:10.1016/j.cgh.2019.07.053.
5. Aro P, Talley NJ, Johansson SE, Agréus L, Ronkainen J. Anxiety is linked to new‐onset dyspepsia in the Swedish population: a 10-year follow‐up study. Gastroenterology 2015;148(5):928‐37. doi: 10.1053/j.gastro.2015.01.039.
6. Adibi P, Keshteli AH, Daghaghzadeh H, Roohafza H, Pournaghshband N, Afshar H. Association of anxiety, depression, and psychological distress in people with and without functional dyspepsia. Adv Biomed Res 2016;5:195. doi:10.4103/2277-9175.190936

Disclosure

None to declare

Introduction

Depression and anxiety are common yet underrecognized comorbidities in patients with pancreatitis. While evidence suggests a significant psychological burden in these patients, the underlying mechanisms remain unclear, and psychological management is not routinely implemented in clinical care. This study aims to assess the prevalence of these conditions and highlight the need for their integration into pancreatitis treatment.

Aims & Methods

Our protocol was registered on PROSPERO (CRD42023481739). We conducted a comprehensive search on November 10, 2023, across three databases - MEDLINE, Embase, and CENTRAL - to identify studies reporting on the prevalence of depression and anxiety symptoms in patients with pancreatitis. We used a random-effects model to calculate the pooled proportion rate and mean differences (MD) with 95% confidence intervals (CI), as well as a pooled single-mean analysis of the psychological questionnaire data.

Results

In total, 43 studies were included in our meta-analysis. Among patients with acute pancreatitis (AP), anxiety was reported in approximately 23% of cases (CI: 7-54), whereas in chronic pancreatitis (CP), the prevalence was higher at 31% (CI: 23-39). Depressive symptoms were identified in approximately 29% of AP patients (CI: 14-51) and 39% of CP patients (CI: 30-48). The pooled single-mean analysis of questionnaire data further underscored the severity of these psychological symptoms, with scores exceeding established clinical cut-off points. For depressive symptoms, mean scores were as follows: CESD-10 (14.30 [CI: 6.69-21.92]), HADS (8.23 [CI: 4.53-11.94]), and SES (49.29 [CI: 44.01-54.57]). Similarly, anxiety symptom severity was reflected in the following measures: HADS (8.67 [CI: 4.53-11.94]) and SAS (47.75 [CI: 35.05-60.45])

Conclusion

There is a significant prevalence of both anxiety and depression in patients with pancreatitis. There is a need to integrate psychological interventions into the treatment of pancreatitis to potentially improve clinical outcomes.