One picture summary: How to treat irritable bowel syndrome with anxiety and depression?

Introduction Irritable bowel syndrome (IBS) and common mental disorders (such as anxiety and depression) often occur at the same time, but most of the current clinical trials on IBS still regard the disease as an isolated intestinal disease.

This article focuses on the treatment of IBS patients with common mental disorders.

Epidemiology shows that the prevalence of IBS combined with common mental disorders is higher.
The risk of anxiety or depression symptoms in IBS patients is three times that of healthy people without IBS.

A systematic review and meta-analysis showed that more than 1/3 of IBS patients have anxiety symptoms, and more than 1/4 of IBS patients have depression symptoms, which is much higher than that of healthy people.

In addition, although IBS has the same prevalence of depression in patients with inflammatory bowel disease, depression is more severe in IBS.

Functional gastrointestinal disease combined with certain gastrointestinal symptoms may also increase the risk of common mental disorders.

An observational secondary medical study data shows that compared with patients with IBS alone, patients with IBS combined with functional dyspepsia are almost 4 times more likely to have symptoms of anxiety and depression.

The prevalence of anxiety and depression also increases with the presence of specific comorbid symptoms (such as upper abdominal pain and urgency).

Compared with other IBS subtypes, patients with constipated IBS are more likely to experience anxiety.

One picture summary: IBS combined with common mental disorders treatment methods For the treatment of IBS combined with common mental disorders, patients must first be prepared.

Taking into account factors such as clinical pressure and patient wishes, it is often not feasible to screen patients with physical symptoms for psychological symptoms.

However, studies have shown that compared with patients with severe mental illness or personality disorder, who wish to be cured, or have no time to participate in treatment, those who are open to the simultaneous treatment of IBS and mental disorders, recognize the influence of emotions on symptoms, and have time to participate in treatment Patients are more likely to get a treatment response.

Figure 1 summarizes some of the treatment modalities that may have a dual effect on the gut-brain axis in the treatment of IBS.

Figure 1 IBS therapy effective for gastrointestinal and psychological symptoms CBT: cognitive behavioral therapy; TCA: tricyclic antidepressants; SNRI: selective serotonin and norepinephrine reuptake inhibitors; SSRI: choice Sex serotonin reuptake inhibitor.

Although the prevalence of IBS combined with common mental disorders is relatively high, little attention has been paid to its psychological concomitant diseases in previous randomized controlled trials of IBS.

It is recommended that when the multidisciplinary research team conducts trials in the future, the design, implementation and analysis of IBS combined with common mental disorders should take into account the true treatment effects of patients with IBS alone and patients with common mental disorders.

Literature index: Staudacher HM, Mikocka-Walus A, Ford AC.
Common mental disorders in irritable bowel syndrome: pathophysiology, management, and considerations for future randomised controlled trials[J].
Lancet Gastroenterol Hepatol.
2021 Feb 12;S2468-1253(20 ) 30363-0.