The frequent co-occurrence of irritable bowel syndrome and the common mental disorders of anxiety and depression is well established. A range of biological and psychosocial disease mechanisms are common to both disorders, many of which contribute to a dysregulated gut–brain axis. Clinical and subthreshold psychological comorbidity adds to the functional impairment and disease burden in individuals with irritable bowel syndrome. Progress is being made with regard to understanding irritable bowel syndrome in the clinical setting from a biopsychosocial perspective. However, until now, most trials of irritable bowel syndrome treatment still consider the disease as a gut disorder in isolation, which leaves major gaps in knowledge about disease–disease interactions and treatment outcomes in irritable bowel syndrome. In this Viewpoint, we review the epidemiology, pathophysiology, and management of anxiety and depression in individuals with irritable bowel syndrome. We also provide methodological recommendations for future randomised controlled trials and outline guidance for research that better incorporates psychiatric comorbidity into its design, with a view to improve treatment outcomes for individuals with irritable bowel syndrome.

肠易激综合征的频繁并发和焦虑和抑郁的常见精神障碍已得到充分证实。两种疾病共有一系列生物学和社会心理疾病机制，其中许多机制都导致肠脑轴失调。临床和阈下心理合并症增加了肠易激综合症患者的功能障碍和疾病负担。从生物心理角度看，在临床环境中对肠易激综合症的了解正在取得进展。但是，直到现在，大多数肠易激综合症治疗试验仍将疾病视为孤立的肠道疾病，这使得人们对肠易激综合症的疾病-疾病相互作用和治疗结果的认识存在重大差距。在这个观点上，我们回顾了肠易激综合症患者的流行病学，病理生理以及焦虑和抑郁的管理。我们还为将来的随机对照试验提供了方法学建议，并为更好地将精神病合并症纳入其设计的研究概述了指南，以期改善肠易激综合症患者的治疗效果。