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Neuroimmune Crossroads: Pathophysiological Links Between Bipolar Disorder and Inflammatory Bowel Disease
Giuseppe Marano1, Francesca Bardi1, Emanuela De Chiara1
1Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Actas Espanolas De Psiquiatria
|December 24, 2025
Summary
Bipolar disorder (BD) and inflammatory bowel disease (IBD) frequently co-occur, impacting patient health and treatment. Shared inflammatory pathways and a gut-brain axis link these conditions, necessitating integrated care.
Area of Science:
- Neuroscience
- Gastroenterology
- Immunology
Background:
- Bipolar disorder (BD) and inflammatory bowel disease (IBD) frequently co-occur, presenting complex treatment challenges.
- Shared inflammatory mechanisms are implicated, but the clinical and pathophysiological interplay between BD and IBD is poorly understood.
Purpose of the Study:
- To review the existing literature on the comorbidity of bipolar disorder and inflammatory bowel disease.
- To characterize the clinical, epidemiological, and mechanistic aspects of BD-IBD overlap.
Main Methods:
- A narrative review of peer-reviewed literature from January 2000 to May 2025 was conducted.
- Searches were performed in PubMed, Web of Science, and PsycINFO using terms related to BD, IBD, comorbidity, and inflammatory markers.
- Studies reporting clinical, epidemiological, or mechanistic data on BD-IBD overlap were included after screening.
Main Results:
- BD affects 3-7% of IBD patients, significantly higher than the general population (1-2%).
- Comorbid BD-IBD is linked to increased hospitalizations, severe GI and psychiatric symptoms, and reduced quality of life.
- Complex treatment interactions exist, with potential exacerbation of inflammation by psychiatric medications and mood destabilization by IBD treatments. Dysregulated cytokines, gut-microbiome alterations, and genetic factors are implicated mechanistic pathways.
Conclusions:
- The co-occurrence of BD and IBD highlights a bidirectional gut-brain neuroimmune axis mediated by systemic inflammation.
- Integrated, multidisciplinary care is essential for managing this comorbidity.
- Future research should prioritize longitudinal studies and targeted anti-inflammatory interventions for improved patient outcomes.
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