Objective The role of the brain–gut axis is of increasing interest in IBD, as the link between common mental disorders and GI inflammation may be bidirectional. We performed a systematic review examining these issues. Design We searched EMBASE Classic and EMBASE, Medline, and APA PsychInfo (to 11 July 2021) for longitudinal follow-up studies examining effect of symptoms of anxiety or depression on subsequent adverse outcomes in IBD, or effect of active IBD on subsequent development of symptoms of anxiety or depression. We pooled relative risks (RRs) and HRs with 95% CIs for adverse outcomes (flare, escalation of therapy, hospitalisation, emergency department attendance, surgery or a composite of any of these) according to presence of symptoms of anxiety or depression at baseline, or RRs and HRs with 95% CIs for new onset of symptoms of anxiety or depression according to presence of active IBD at baseline. Results We included 12 separate studies, recruiting 9192 patients. All 12 studies examined brain-to-gut effects. Anxiety at baseline was associated with significantly higher risks of escalation of therapy (RR=1.68; 95% CI 1.18 to 2.40), hospitalisation (RR=1.72; 95% CI 1.01 to 2.95), emergency department attendance (RR=1.30; 95% CI 1.21 to 1.39), or a composite of any adverse outcome. Depression at baseline was associated with higher risks of flare (RR=1.60; 95% CI 1.21 to 2.12), escalation of therapy (RR=1.41; 95% CI 1.08 to 1.84), hospitalisation (RR=1.35; 95% CI 1.17 to 1.57), emergency department attendance (RR=1.38; 95% CI 1.22 to 1.56), surgery (RR=1.63; 95% CI 1.19 to 2.22) or a composite of any of these. Three studies examined gut-to-brain effects. Active disease at baseline was associated with future development of anxiety or depression (RR=2.24; 95% CI 1.25 to 4.01 and RR=1.49; 95% CI 1.11 to 1.98, respectively). Conclusion Bidirectional effects of the brain–gut axis are present in IBD and may influence both the natural history of the disease and psychological health. Data are available upon reasonable request. Data are available upon reasonable request from the corresponding author.

中文翻译：

---

双向脑肠轴效应影响 IBD 的情绪和预后：系统评价和荟萃分析

目的 脑-肠轴在 IBD 中的作用越来越受到关注，因为常见精神障碍和胃肠道炎症之间的联系可能是双向的。我们对这些问题进行了系统评价。设计 我们搜索了 EMBASE Classic 和 EMBASE、Medline 和 APA PsychInfo（至 2021 年 7 月 11 日），以进行纵向随访研究，检查焦虑或抑郁症状对 IBD 后续不良结果的影响，或活动性 IBD 对后续症状发展的影响的焦虑或抑郁。根据基线时焦虑或抑郁症状的存在，我们汇总了不良结局（突发、治疗升级、住院、急诊就诊、手术或其中任何一项）的相对风险 (RR) 和 HR，CI 为 95%，或根据基线活动性 IBD 的存在，具有 95% CI 的 RR 和 HR 用于新出现的焦虑或抑郁症状。结果 我们纳入了 12 项独立的研究，招募了 9192 名患者。所有 12 项研究都检查了大脑对肠道的影响。基线焦虑与治疗升级（RR=1.68；95% CI 1.18 至 2.40）、住院（RR=1.72；95% CI 1.01 至 2.95）、急诊就诊（RR=1.30；95%）风险显着增加相关CI 1.21 至 1.39），或任何不良结果的复合。基线时的抑郁与更高的发作风险（RR=1.60；95% CI 1.21 至 2.12）、治疗升级（RR=1.41；95% CI 1.08 至 1.84）、住院（RR=1.35；95% CI 1.17 至1.57）、急诊科出勤率（RR=1.38；95% CI 1.22 至 1.56）、手术（RR=1.63；95% CI 1.19 至 2.22）或其中任何一项的复合。三项研究检查了肠道对大脑的影响。基线时的活动性疾病与未来焦虑或抑郁的发展相关（RR=2.24；95% CI 1.25 至 4.01 和 RR=1.49；95% CI 1.11 至 1.98）。结论 IBD 中存在脑-肠轴的双向效应，并可能影响疾病的自然病程和心理健康。可根据合理要求提供数据。数据可根据通讯作者的合理要求提供。可根据合理要求提供数据。数据可根据通讯作者的合理要求提供。可根据合理要求提供数据。数据可根据通讯作者的合理要求提供。