Impact of Psychopathology and Gut Microbiota on Disease Progression in Ulcerative Colitis: A Five-Year Follow-Up Study

Psychological distress and gut dysbiosis play key roles in IBD. This study investigated whether specific psychopathological and gut microbiota features predict adverse outcomes in UC patients. This retrospective cohort study included 35 UC patients recruited in 2019. Baseline assessments involved clinical interviews, psychiatric evaluations, and stool sampling. In 2024, follow-up interviews and medical record reviews assessed disease progression, including biologic therapy failure, hospitalization, surgery, and diagnosis changes. Disease activity was measured via the Mayo score. Psychological testing included MMPI-2, STAI-Y2, GSES, CD-RISC, and TAS-20. Patients with biological therapy failure showed increased levels of Proteobacteria, Fusobacteria, Enterobacteriaceae, and <i>Trabulsiella</i>, while Firmicutes were less abundant. UC-related hospitalized patients had lower levels of Rikenellaceae, Ruminococcaceae, <i>Faecalibacterium</i>, <i>Lachnospira</i>, <i>Methanobrevibacter</i>, and <i>Phascolarctobacterium</i> compared to non-hospitalized patients. Hospitalized patients scored higher on the Sc clinical scale and the OBS and HEA content scales. <i>Acidaminococcus</i> and <i>Bilophila</i> were more abundant in patients who underwent surgery. PCA revealed differences between patients with and without biological failure. Logistic regression found that Fusobacteria were negatively correlated with the failure of three or more biologics, while Hy and Pd were positively correlated. Pa and Pt were negatively correlated with multifailure. Obsessiveness, health concerns, somatization, and reduced SCFA-producing bacteria may predict UC-related adverse outcomes.