When the Mind Meets the Gut: Unravelling the Anxiety-IBS Link with GAD-7 and Rome IV
Abdullah Farooq1, Taimour Mushtaq2, Mubariz Ali3, Prachi Dawer4, Huzaifa Nawaz5, Hafiz Sohail Ashraf6
1Lahore Medical and Dental College Pakistan, 2Lahore Medical and Dental College Pakistan, 3CMH Kharian Medical College, Kharian Cantt, Punjab, Pakistan, 4University College of Medical Sciences New Delhi India, 5Services Institute of Medical Sciences (SIMS), Ghaus-ul-Azam Jail Road, Lahore, Pakistan 54000, 6Carle foundation Hospital Urbana Illinois
Objective:
The purpose of this study was to investigate the relationship between anxiety intensity, as evaluated by the Generalized Anxiety Disorder 7-item (GAD-7) scale, and the prevalence of irritable bowel syndrome (IBS) diagnosed using Rome IV criteria, with an emphasis on brain-gut interactions important to neurology.
Background:
The brain-gut axis, or bidirectional connection between the central nervous system and the gastrointestinal tract, plays an important role in functional GI diseases. Anxiety is common in neurological practice and has been associated to visceral hypersensitivity, altered autonomic signalling, and decreased pain regulation at the cerebral level. IBS, a paradigmatic condition of gut-brain connection, usually coexists with anxiety, although the gradient of this relationship is unknown. Clarifying this relationship may contribute to better integrated neurologic and psychological treatment.
Design/Methods:
Data from 330 individuals were evaluated, with 90 (27.3%) meeting Rome IV IBS criteria. The GAD-7 scale was used to classify anxiety intensity as low, mild, moderate, or severe. Mann-Whitney U tests were used to compare the mean GAD-7 scores in the IBS and non-IBS groups. Chi-square tests and post-hoc Fisher's exact analyses were used to investigate associations across anxiety strata, with Bonferroni correction applied for multiple comparisons.
Results:
Patients with IBS showed considerably higher mean GAD-7 scores than those without IBS (8.16 vs. 5.48; p < 0.001). IBS prevalence rose gradually with anxiety severity: 20.3% (minimum), 25.5% (mild), 36.4% (moderate), and 51.9% (severe). Severe anxiety was significantly related to IBS (OR = 4.23, 95% CI 1.78-10.04, adjusted p = 0.004).
Conclusions:
Severe anxiety increases the chance of IBS fourfold, emphasizing the crucial connection between brain emotional networks and gastrointestinal function. Although causality cannot be determined, our findings highlight the neurologic value of screening for anxiety in IBS and promote integrated brain-gut therapy methods to improve patient outcomes.
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