The association of psychological distress with microbiota alterations in patients suffering from quiescent inflammatory bowel disease

The role of the gut microbiota and brain-gut axis in inflammatory bowel disease (IBD), a group of multifactorial chronic disorders of uncertain etiology, is receiving increasing attention. However, little attention has been paid to the role of disease activity and psychological status in the composition of these patients' gut microbiota. To minimize the confounding effects of active inflammation, consecutive IBD patients characterized by symptom remission over the past year were recruited and assessed for psychological distress (HADS and PSS), quality of life (IBDQ), intestinal symptoms (GSRS-IBS), and microbiota composition. Analysis of the gut microbiota revealed that 55.75% of patients exhibited gut dysbiosis (microbial imbalance), while 44.25% exhibited altered microbiota (any change in the composition or function of the microbial community). Higher intestinal symptoms and poorer quality of life were directly associated with higher levels of Actinobacteria (p ' .05). However, multiple regression revealed that perceived stress and anxiety could independently predict gut dysbiosis. Our results suggest that gut dysbiosis is a stable condition not influenced by disease activity but closely related to psychological distress. If confirmed, these findings could impact the clinical management of IBD by helping to identify patients at higher risk for acute intestinal and psychological symptoms, even when they are in remission.