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Encrucijada Inmunoneuronal: Vínculos Fisiopatológicos entre el Trastorno Bipolar y la Enfermedad Inflamatoria
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
Resumen
El trastorno bipolar (TB) y la enfermedad inflamatoria intestinal (EII) coexisten con frecuencia, afectando la salud y el tratamiento de los pacientes. Las vías inflamatorias compartidas y un eje intestino-cerebro vinculan estas afecciones, lo que requiere una atención integrada.
Área de la Ciencia:
- Neurociencia
- Gastroenterología
- Inmunología
Sus antecedentes:
- El trastorno bipolar (TB) y la enfermedad inflamatoria intestinal (EII) coexisten con frecuencia, presentando complejos desafíos de tratamiento.
- Se implican mecanismos inflamatorios compartidos, pero la interacción clínica y fisiopatológica entre el TB y la EII es poco comprendida.
Objetivo del estudio:
- Revisar la literatura existente sobre la comorbilidad del trastorno bipolar y la enfermedad inflamatoria intestinal.
- Caracterizar los aspectos clínicos, epidemiológicos y mecanísticos de la superposición TB-EII.
Principales métodos:
- Se realizó una revisión narrativa de la literatura revisada por pares de enero de 2000 a mayo de 2025.
- Se realizaron búsquedas en PubMed, Web of Science y PsycINFO utilizando términos relacionados con TB, EII, comorbilidad y marcadores inflamatorios.
- Se incluyeron estudios que informaban datos clínicos, epidemiológicos o mecanísticos sobre la superposición TB-EII después de la selección.
Principales resultados:
- El TB afecta al 3-7% de los pacientes con EII, significativamente más alto que en la población general (1-2%).
- La comorbilidad TB-EII se asocia con un aumento de las hospitalizaciones, síntomas gastrointestinales y psiquiátricos graves, y una reducción de la calidad de vida.
- Existen complejas interacciones en el tratamiento, con posible exacerbación de la inflamación por medicamentos psiquiátricos y desestabilización del estado de ánimo por tratamientos de la EII.
- Las vías mecanísticas implicadas incluyen citoquinas desreguladas, alteraciones de la microbiota intestinal y factores genéticos.
Conclusiones:
- La coexistencia de TB y EII resalta un eje neuroinmunológico bidireccional intestino-cerebro mediado por la inflamación sistémica.
- La atención integrada y multidisciplinaria es esencial para el manejo de esta comorbilidad.
- La investigación futura debe priorizar estudios longitudinales e intervenciones antiinflamatorias dirigidas para mejorar los resultados de los pacientes.
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