Alexithymic characteristics and interoceptive abilities are associated with disease severity and levels of C-reactive protein and cytokines in patients with inflammatory bowel disease

Eleni Vinni; Katerina Karaivazoglou; Evanthia Tourkochristou; Efthymios Tsounis; Maria Kalogeropoulou; Georgia Konstantopoulou; Theoni Lourida; Theodora Kafentzi; Efi Lampropoulou; Maria Rodi; Ioanna Aggeletopoulou; Georgia Diamantopoulou; Georgios Theocharis; Konstantinos Thomopoulos; Philippos Gourzis; Athanasia Mouzaki; Christos Triantos

doi:10.20524/aog.2023.0813

Alexithymic characteristics and interoceptive abilities are associated with disease severity and levels of C-reactive protein and cytokines in patients with inflammatory bowel disease

Ann Gastroenterol. 2023 Jul-Aug;36(4):412-422. doi: 10.20524/aog.2023.0813. Epub 2023 Jun 14.

Authors

Eleni Vinni¹, Katerina Karaivazoglou², Evanthia Tourkochristou¹, Efthymios Tsounis¹, Maria Kalogeropoulou², Georgia Konstantopoulou², Theoni Lourida¹, Theodora Kafentzi¹, Efi Lampropoulou¹, Maria Rodi³, Ioanna Aggeletopoulou^{1

3}, Georgia Diamantopoulou¹, Georgios Theocharis¹, Konstantinos Thomopoulos¹, Philippos Gourzis², Athanasia Mouzaki³, Christos Triantos¹

Affiliations

¹ Division of Gastroenterology, Department of Internal Medicine (Eleni Vinni, Evanthia Tourkochristou, Efthymios Tsounis, Theoni Lourida, Theodora Kafentzi, Efi Lampropoulou, Ioanna Aggeletopoulou, Georgia Diamantopoulou, Georgios Theocharis, Konstantinos Thomopoulos, Christos Triantos).
² Department of Psychiatry (Katerina Karaivazoglou, Maria Kalogeropoulou, Georgia Konstantopoulou, Philippos Gourzis).
³ Division of Hematology, Department of Internal Medicine, Medical School (Maria Rodi, Ioanna Aggeletopoulou, Athanasia Mouzaki), University of Patras, Greece.

Abstract

Background: Alexithymia and atypical gut-brain signaling have been linked to the pathophysiology of inflammatory bowel disease (IBD). We herein assessed IBD patients' alexithymia levels and interoceptive abilities, and detected potential correlations with psychological distress, symptom severity and disease activity, and inflammation indices.

Methods: Adult IBD outpatients and healthy controls were recruited. Alexithymia was assessed using the Toronto Alexithymia Scale, interoceptive accuracy using the Heartbeat Counting Test (cardiac interoception) and the Water Load Test-II (gastric interoception), and interoceptive sensibility using the Multidimensional Assessment of Interoceptive Awareness (MAIA).

Results: Forty-one patients with Crohn's disease (CD), 16 with ulcerative colitis (UC), and 50 healthy controls were included. In CD patients, the level of externally oriented thinking and total alexithymia score were correlated with disease activity (P=0.027 and P=0.047, respectively), while in UC patients difficulties in identifying emotions were linked to disease activity (P=0.007). In CD patients, the Noticing, Not-Worrying and Emotional Awareness MAIA subscale score were correlated with C-reactive protein levels (P=0.005, P=0.048 and P=0.005), the Noticing subscale score with interleukin (IL)-1β levels (r=-0.350, P=0.039), the Not-Distracting subscale score with IL-6 levels (r=-0.402, P=0.017), and the Emotional Awareness subscale score with IL-1β (r=-0.367, P=0.030) and IL-6 (r=-0.379, P=0.025) levels. Finally, in UC patients, the Not-Worrying subscale score was significantly associated with IL-6 levels (r=-0.532, P=0.049), while difficulties in identifying emotions were linked to IL-8 levels (r=0.604, P=0.022).

Conclusion: Emotional and interoceptive processing is associated with IBD disease activity, suggesting a potential implication for IBD pathophysiology.

Keywords: Alexithymia; cytokines; inflammatory bowel disease; interoception.