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Review
. 2025 Jan 27;47(1):12.
doi: 10.1007/s00281-025-01036-x.

Role of the gut microbiome in psychological symptoms associated with inflammatory bowel diseases

Konstantina Atanasova  1   2 , Laura-Louise Knödler  3 , Wolfgang Reindl  3 , Matthias Philip Ebert  3 , Anne Kerstin Thomann  3
Affiliations
Review

Role of the gut microbiome in psychological symptoms associated with inflammatory bowel diseases

Konstantina Atanasova et al. Semin Immunopathol. .

Abstract

The brain-gut axis constitutes the basis for the bidirectional communication between the central nervous system and the gastrointestinal tract driven by neural, hormonal, metabolic, immunological, and microbial signals. Alterations in the gut microbiome composition as observed in inflammatory bowel diseases can modulate brain function and emerging empirical evidence has indicated that interactions among the brain-gut microbiome-axis seem to play a significant role in the pathogenesis of both inflammatory bowel diseases and psychiatric disorders and their comorbidity. Yet, the immunological and molecular mechanisms underlying the co-occurrence of inflammatory bowel diseases and psychological symptoms are still poorly understood. The aim of this narrative review is to highlight contemporary empirical findings supporting a pivotal role of the gut microbiome in the pathophysiology of highly prevalent neuropsychiatric symptoms in inflammatory bowel diseases such as fatigue, depression, and anxiety. Finally, we focus on microbiome modulation as potential treatment option for comorbid neuropsychiatric symptoms in immune-mediated diseases and especially in inflammatory bowel diseases. High-quality clinical trials are required to clarify how microbiome modulation through dietary interventions or probiotic, prebiotic or synbiotic treatment can be used clinically to improve mental health and thus quality of life of patients with inflammatory bowel diseases.

Keywords: Anxiety; Brain-gut axis; Depression; Fatigue; Gut microbiome; Inflammatory bowel disease.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Prisma Flow Diagram visualizing the selection and filtering process of the conducted systematic literature search. (A) Studies investigating the role of gut microbiome in the link between inflammatory bowel disease and mental health; (B) Studies investigating pro-, pre- and synbiotic treatment in mental health disorders and inflammatory bowel disease
Fig. 2
Fig. 2
Communication pathways between the brain and gut microbiome in IBD. Comorbid psychological symptoms such as depression, anxiety and fatigue have been linked to altered gut microbiome and gut dysbiosis in IBD. Figure created in https://BioRender.com
Fig. 3
Fig. 3
Immunonutrition, probiotic, prebiotic and synbiotic treatments as opportunity to modulate the gut microbiome in IBD by increasing the production of SCFA, downregulating the HPA axis and modulating tryptophan metabolism. Microbiome modulation can result in diminished inflammation, as well as reduced symptoms of depression, anxiety and fatigue in IBD. Figure created in https://BioRender.com
See this image and copyright information in PMC

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