They are called chronic inflammatory bowel diseases, because they affect the intestine. But ulcerative colitis and Crohn’s disease don’t just affect the gut, as evidenced by the long list of extra-intestinal symptoms that can affect, for example, the joints and eyes. The impact of inflammation can in fact go far beyond the body, affecting other districts, even the brain, often contributing to generating states of anxiety and depression. Which can also affect the effectiveness of treatments. This was remembered by the experts gathered during the event dedicated to chronic inflammatory diseases at Humanitas University, promoted by Galápagos Biopharma Italy together with the IRCCS Humanitas Clinical Institute.
Chronic inflammatory bowel diseases
Chronic inflammatory bowel diseases (acronym MICI) are estimated to affect about 250,000 people in Italy, for life as the name suggests, but with an often fluctuating trend. Acute phases of the diseases – accompanied by abdominal pain, fevers, diarrhea and frequent rushes to the bathroom, blood in the stool – alternate with phases of relative well-being, more or less lasting in patients, who tend to be young when they discover the disease. Patients who, not infrequently, also suffer from anxiety and depression. To what extent are these a consequence of the diseases or how much should they be considered as symptoms, like other extraintestinal manifestations of the diseases?
Focus on the gut-brain axis
It is starting from this question, and following the line of research on the gut-brain axis, that the team of Maria Rescigno, head of the Mucosal and Microbiota Immunology Laboratory of Humanitas and Deputy Vice Rector with responsibility for Research at Humanitas University, analyzed if and how inflammation in the intestine can spread to the brain. Last fall, in a study published in Science, he and his team of researchers demonstrated that this is indeed the case, also identifying how the spread of inflammation occurs: “At the level of the brain we have identified a new vascular barrier in the chorioid plexus, a sort of gate that is normally open and allows a dialogue between the brain and our organism – explained Rescigno – this gate closes in the face of the danger of strong intestinal inflammation to prevent its spread to the brain. When the dialogue between brain and organism stops, the brain isolates itself and undergoes phenomena of anxiety and depression. “
The closure of this gate, through which in normal conditions also nutrients pass, the experts explain, would be related to the alteration of the integrity of another barrier, the vascular one at the level of the intestine. It would be this intestinal permeability to favor the passage of bacteria from the intestinal microbiota and molecules that can reach the brain, making this intestinal-brain communication path a possible target in the development of new treatments. Also because the states of anxiety and depression not only worsen the quality of life of patients, but can also influence their response to treatments.
The importance of also addressing aspects of anxiety and depression in IBD
This was explained during the event by Antonino Spinelli, Head of the Colon and Rectal Surgery Unit of Humanitas, co-director of the IBD Center of Humanitas and professor of Humanitas University, citing the results of a recent research: “We have just published in the British Journal of Surgery a study conducted together with the University of Barcelona, in which we observe how patients who have scores of anxiety and major depression before surgery have worse outcomes. It is a strong correlation between the psychological dimension and a more strictly biological dimension with important implications. In fact, in inflammatory diseases we have a time window in which we operate, and we can improve these aspects and thus hope to optimize the post-operative outcome “.