Depression with GI symptoms should prompt IBD investigation
Patients who have experienced gastrointestinal symptoms before the onset of depression were at increased risk for an eventual diagnosis of inflammatory bowel disease, according to research published in Gut.
Richard C. Pollok, of St. George’s University Hospitals in the United Kingdom, and colleagues wrote that both immune dysregulation and inflammation due to IBD may be linked with depression, which has been observed in other immune-mediated diseases.
“This indicates the apparent association between prior depression and subsequent IBD potentially represents reverse causation, whereby symptoms of IBD result in depression rather than the other way around,” they wrote. “Previous studies have not accounted for the ordering of such ‘prodromal’ GI symptoms, common in the years leading up to the diagnosis of IBD, in relation to the emergence of depression.”
Researchers conducted a nested case-control study using data from the Clinical Practice Research Datalink. They included incident cases of ulcerative colitis (n = 10,829) and Crohn’s disease (n = 4,531) from 1998 to 2016 and matched those patients with control individuals without IBD (n = 15,360). Within the study, investigators created two sub-groups with prevalent depression based on if the individuals reported GI symptoms before or after the onset of depression.
Pollok and colleagues found that there was an excess of prevalent depression 5 years before IBD diagnosis relative to controls (UC: 3.7% vs. 2.7%; CD: 3.7% vs. 2.9%). Individuals who reported GI symptoms prior to a diagnosis of depression were at increased risk for developing UC (OR = 1.47; 95% CI, 1.21-1.79) and CD (OR = 1.41; 95% CI, 0.91-1.38) compared with those without depression.
Additionally, individuals with just depression and no GI symptoms had similar risks for UC and CD to those without depression.
Although their findings did not show an association between depression — without GI symptoms — and IBD, Pollok and colleagues wrote that an excess of depression in the years before IBD diagnosis shows that holistic approach is needed for patients who present with GI symptoms.
“We found individuals who experienced GI symptoms before the recorded onset of depression were at an increased risk of eventually receiving a diagnosis of IBD,” they wrote. “This suggests that depression may arise secondary to GI symptoms experienced during the period prior to the diagnosis of IBD. Our findings may relate to diagnostic delay in IBD and further research is needed to ascertain the burden of such delays and their relationship with other comorbidities including poor mental health.”