The key role of anxiety in clinical disease activity of adult Inflammatory Bowel Disease patients

Background. Inflammatory Bowel disease (IBD) patients, both UC (Ulcerative colitis) and CD (Crohn’s disease), often experience mood disorders and may show persistent physical symptomatology despite absence of inflammation. The aim of present study was to explore associations between clinical activity, psychological distress, personality traits, and inflammation biomarkers in a sample of IBD patients receiving biological treatment. Methods. This cross-sectional study included 57 adult IBD patients (31 UC, 26 CD) admitted to the GI unit of San Salvatore hospital in L’Aquila (Italy) between September 2023 and February 2024. Clinical activity was assessed with Partial Mayo score (PMS) and Harvey-Bradshaw index (HBI), while psychological disturbances and personality traits with DASS-21 and Big-five inventory (BFI-10) questionnaires, respectively. We included inflammation biomarkers such as Fecal calprotectin (FC) and C-reactive protein (CRP). Binomial logistic regression was performed to identify factors associated with clinical activity. Results. The analysis of psychological factors showed that anxiety levels were the only significant predictor of clinical activity (OR=1.775 95% CI: 1.149-2.74; p= .01). The regression model including inflammation biomarkers highlighted a significant predictive effect of FC (OR=1.002 95% CI: 1.0004-1.004; p= .014). We also performed an additional model focusing on anxiety and FC levels. This analysis confirmed a more robust association between clinical activity and anxiety levels compared to FC (OR=1.533 95% CI: 1.13-2.076; p=.006 vs OR=1.0028 95% CI: 1.00-1.005; p=.016) Conclusion: Anxiety appears to be strongly associated to clinical activity presence, more than FC levels, suggesting a greater influence of psychological distress on intestinal symptomatology. IBD management should also focus on psychological distress.