Associations between brain morphology, inflammatory markers and symptoms of fatigue, depression or anxiety in active and remitted Crohn's disease

Anne K Thomann; Mike M Schmitgen; Jule C Stephan; Matthias P Ebert; Philipp A Thomann; Kristina Szabo; Wolfgang Reindl; R Christian Wolf

doi:10.1093/ecco-jcc/jjae078

Associations between brain morphology, inflammatory markers and symptoms of fatigue, depression or anxiety in active and remitted Crohn's disease

J Crohns Colitis. 2024 May 17:jjae078. doi: 10.1093/ecco-jcc/jjae078. Online ahead of print.

Authors

Anne K Thomann¹, Mike M Schmitgen², Jule C Stephan¹, Matthias P Ebert¹, Philipp A Thomann³, Kristina Szabo⁴, Wolfgang Reindl¹, R Christian Wolf²

Affiliations

¹ Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
² Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
³ Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, Karlsbad, Germany.
⁴ Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

PMID: 38757201
DOI: 10.1093/ecco-jcc/jjae078

Abstract

Background: Fatigue and psychosocial impairments are highly prevalent in IBD, especially during active disease. Disturbed brain-gut-interactions may contribute to these symptoms. This study examined associations between brain structure, faecal calprotectin and symptoms of fatigue, depression and anxiety in persons with Crohn's Disease (CD) in different disease states.

Methods: In this prospective observational study, n=109 participants (n=67 persons with CD, n=42 healthy controls) underwent cranial magnetic resonance imaging, provided stool samples for analysis of faecal calprotectin and completed questionnaires to assess symptoms of fatigue, depression and anxiety. We analysed differences in grey matter volume (GMV) between patients and controls and associations between regional GMV alterations, neuropsychiatric symptoms and faecal calprotectin.

Results: Symptoms of fatigue, depression and anxiety were increased in patients with CD compared to controls, with highest scores in active CD. Patients exhibited regionally reduced GMV in cortical and subcortical sensorimotor regions, occipitotemporal and medial frontal areas. Regional GMV differences showed a significant negative association with fatigue, but not with depression or anxiety. Subgroup analyses revealed symptom-GMV-associations for fatigue in remitted, but not in active CD, while fatigue was positively associated with faecal calprotectin in active, but not remitted disease.

Conclusion: Our findings support disturbed brain-gut-interactions in CD which may be particularly relevant for fatigue during remitted disease. Reduced GMV in the precentral gyrus and other sensorimotor areas could reflect key contributions to fatigue pathophysiology in CD. A sensorimotor model of fatigue in CD could also pave the way for novel treatment approaches.

Keywords: Brain-gut interactions; Crohn’s Disease; Fatigue.

© The Author(s) 2024. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.