Bidirectional relationship between anxiety and gastrointestinal symptoms: a case control study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20253752Keywords:
Anxiety, Bidirectional link, Gastrointestinal symptoms, Gut-brain axis, Gut microbiome, Quality of lifeAbstract
Background: Many patients of anxiety manifest lot of gastrointestinal (GI) symptoms in the form of bloating, diarrhoea, heartburn and constipation. Conversely patients suffering from common GI diseases like irritable bowel syndrome have anxiety symptoms. Severity of one can aggravate the other condition. Gut and brain communicate through gut-brain axis. Gut microbiome and hypothalmo-pituitary-adrenal system and a host of metabolic products play an important role in this axis.
Methods: Thirty-eight patients with moderate-to-severe GI symptoms and anxiety were evaluated with appropriate scales for diagnosis and severity. The quality of life was also assessed in them. Thirty-eight healthy subjects with no GI symptoms and no/mild anxiety symptoms were similarly evaluated as control group.
Results: Key predictors of anxiety severity and GI symptoms severity were statistically analysed. There was a strong link between GI symptoms and anxiety severity and inverse relationship with the quality of life.
Conclusions: Evidence suggests a bidirectional relationship between gastrointestinal symptom severity and anxiety, mediated by the gut-brain axis.
Metrics
References
Sharky KA, Mawe GM. The enteric nervous system. Physiological reviews. Am Physiol Soc. 2023;103(2):1487-564. DOI: https://doi.org/10.1152/physrev.00018.2022
Sender R, Fuchs S, Milo R. Revised estimates for the number of human and bacteria cells in the body. PLoS Biol. 2016;14(8):e1002533. DOI: https://doi.org/10.1371/journal.pbio.1002533
Berg G, Rybakova D, Fischer D, Cernava T, Vergès MCC, Charles T, et al. Microbiome definition re-visited: old concepts and new challenges. Microbiome. 2020;8(1):103. DOI: https://doi.org/10.1186/s40168-020-00875-0
Chaudhry TS, Senapati SG, Gadam S, Mannam HP, Voruganti HP, Abbasi Z, et al. The impact of microbiota on the gut-brain axis: examining the complex interplay and implications. J Clin Med. 2023;12(16):5231. DOI: https://doi.org/10.3390/jcm12165231
Riehl L, Fürst J, Kress M, Rykalo N. The importance of the gut microbiome and its signals for a healthy nervous system. Front Neurosci. 2024;18:1302957. DOI: https://doi.org/10.3389/fnins.2023.1302957
Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol. 2015;28(2):203-9.
Dong TS, Mayer E, Advances in brain-gut-microbiome interactions: a comprehensive update on signalling mechanisms, disorders, and therapeutic implications. Cell Mol Gastroenterol Hepatol. 2024;18(1):1-13. DOI: https://doi.org/10.1016/j.jcmgh.2024.01.024
Rathore K, Shukla N, Naik S, Sambhav K, Dange K, Bhuyan D, et al. The bidirectional relationship between the gut microbiome and mental health: a comprehensive review. Cureus. 2025;17(3):e80810. DOI: https://doi.org/10.7759/cureus.80810
Zhang X, Tang B, Guo J. Parkinson’s disease and gut microbiota: from clinical to mechanistic and therapeutic studies. Transl Neurodegener. 2023;15(1)12:59. DOI: https://doi.org/10.1186/s40035-023-00392-8
Butler MI, Bastiaanssen TF, Long-Smith C. Morkl S, Berding K, Ritz NL, et al. The gut microbiome in social anxiety disorder: evidence of altered composition and function. Transl Psychiatr. 2023;13:95. DOI: https://doi.org/10.1038/s41398-023-02325-5
Winter G, Hart RA, Charlesworth RP, Sharpley CF. Gut microbiome and depression: what we know and what we need to know. Rev Neurosci. 2018;29(6):629-43. DOI: https://doi.org/10.1515/revneuro-2017-0072
Foster JA, McVey Neufeld KA. Gut-brain axis: how the microbiome influences anxiety and depression. Trends Neurosci. 2013;36(5):305-12. DOI: https://doi.org/10.1016/j.tins.2013.01.005
Zhang R, Zhang M, Wang P. The intricate interplay between dietary habits and cognitive function: insights from the gut-brain axis. Front Nutr. 2025;12:1539355. DOI: https://doi.org/10.3389/fnut.2025.1539355
Aslam H, Green J, Jacka FN, Collier F, Berk M, Pasco J, et al. Fermented foods, the gut and mental health: a mechanistic overview with implications for depression and anxiety. Nutr Neurosci. 2020;23(9):659-71. DOI: https://doi.org/10.1080/1028415X.2018.1544332
Sun L, Zhang H, Cao Y, Wang C, Zhao C, Wang H, et al. Fluoxetine ameliorates dysbiosis in a depression model induced by chronic unpredicted mild stress in mice. Int J Med Sci. 2019;16(9):1260-70. DOI: https://doi.org/10.7150/ijms.37322
Kumar A, Pramanik J, Goyal N, Chauhan D, Sivamaruthi BS, Prajapati BG, et al. Gut microbiota in anxiety and depression: unveiling the relationships and management options. Pharmaceuticals. 2023;16(4):565. DOI: https://doi.org/10.3390/ph16040565
Thompson E. Hamilton rating scale for anxiety (HAM-A). Occup Med. 2015;65(7):601. DOI: https://doi.org/10.1093/occmed/kqv054
Revicki DA, Wood M, Wiklund I, Crawley J. Reliability and validity of the gastrointestinal symptom rating scale in patients with gastroesophageal reflux disease. Qual Life Res. 1997;7(1):75-83. DOI: https://doi.org/10.1023/A:1008841022998
Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, et al. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. J Br Surg. 1995;82(2):216-22. DOI: https://doi.org/10.1002/bjs.1800820229
Pradhan G, Samson SL, Sun Y. Ghrelin: much more than a hunger hormone. Curr Opin Clin Nutr Metab Care. 2013;16(6):619-24. DOI: https://doi.org/10.1097/MCO.0b013e328365b9be
Wallon C, Yang PC, Keita AV, Ericson AC, McKay DM, Sherman PM, et al. Corticotropin-releasing hormone (CRH) regulates macromolecular permeability via mast cells in normal human colonic biopsies in vitro. Gut. 2008;57(1):50-8. DOI: https://doi.org/10.1136/gut.2006.117549
Camilleri M. Leaky gut: mechanisms, measurement and clinical implications in humans. Gut. 2019;68(8):1516-26. DOI: https://doi.org/10.1136/gutjnl-2019-318427
Banskota S, Eric Ghia J, Khan WI. Serotonin in the gut: Blessing or a curse. Biochimie. 2019;161:56-64. DOI: https://doi.org/10.1016/j.biochi.2018.06.008
Tanner SE, Burton Murray H, Brown TA, Malik Z, Parkman HP. Gastrointestinal-specific symptom anxiety in patients with gastroparesis: relationships to symptom severity and quality of life. Neurogastroenterol Motil. 2023;35(5):e14534. DOI: https://doi.org/10.1111/nmo.14534
Overs J, Morgan S, Apputhurai P, Tuck C, Knowles SR. Comparing the prevalence and association between anxiety, depression and gastrointestinal symptoms in gastroparesis versus functional dyspepsia: a systematic review and meta-analysis. J Psychosom Res. 2024;183:111834. DOI: https://doi.org/10.1016/j.jpsychores.2024.111834
Farbod F, Farzaneh N, Bijan MD, Mehdi G, Nosratollah N. Psychological features in patients with and without irritable bowel syndrome: a case-control study using Symptom Checklist‑90‑Revised. Indian J Psychiatr. 2015:57(1):68-71. DOI: https://doi.org/10.4103/0019-5545.148526
Seaman A, Ferreira N. Investigating the role of gastrointestinal-specific anxiety and perceived disability in the adjustment to inflammatory bowel disease. Gastrointest Disord. 2024;6:191-201. DOI: https://doi.org/10.3390/gidisord6010014
Alanzi TM, Almumen M, Almogrin M, Asiri A, Alhalal R, Almuslem Z, et al. Examining the relationship between anxiety, depression, and gastrointestinal symptoms among university students: a campus-wide survey analysis. Cureus. 2024;16(9):e69270. DOI: https://doi.org/10.7759/cureus.69270