The gut-brain connection in inflammatory bowel disease: Mechanisms, mental health, and therapeutic horizons

Inflammatory Bowel Disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic inflammatory condition that extends beyond the gut, affecting systemic and psychological health. The microbiota-gut-brain axis plays a pivotal role in its pathogenesis and links IBD to mental health disorders such as depression, anxiety, and cognitive impairment. Dysbiosis, increased intestinal permeability, cytokine-driven neuroinflammation, and hypothalamic-pituitary-adrenal (HPA) axis dysregulation contribute to neuroimmune alterations. Microbial metabolites, including short-chain fatty acids and tryptophan derivatives, further modulate gut–brain signaling. Current therapeutic approaches, probiotics, prebiotics, synbiotics, postbiotics, and lifestyle modifications aim to restore gut balance and psychological well-being, though outcomes vary among patients. Advancing toward personalized medicine through microbiome-based stratification and biomarker-directed therapy holds promise. Future research integrating multi-omics approaches and brain-gut-immune modeling is essential to enhance IBD management, mental health, and overall quality of life.