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P234 Longitudinal course of inflammatory bowel diseases: a model of microbial, immune, and neuropsychological integration

P. Tavakoli*1, U. Vollmer-Conna2, D. Hadzi-Pavlovik2, X. Vazquez-Campos2, M. Grimm1

1University of New South Wales, Department of Medicine, Sydney, Australia, 2University of New South Wales, Sydney, Australia

Background

While there is a literature suggesting associations between gut microbiota, physiological factors, psychological state, immune modulation and IBD, there has been little attempt to integrate these factors over time and assess their interdependence with IBD disease activity. This study pursued longitudinal monitoring in IBD, examining integrated data to explain how major factors associate and interact, leading to exacerbation of symptoms and disease activity.

Methods

59 participants (24 UC, 26 CD, 9 IBS) were followed up for 12 months. Complete longitudinal datasets including demography, disease status (CDAI, Mayo score), monthly stool and blood samples for immune biomarkers, monthly validated scores of psychological state and sleep measures, assessment of physiological state and autonomic nervous system (ANS) function during cognitive tasks, were collected for analysis of association. Microbiome analysis was performed using V4 16S rRNA for identification of microbial phylogenetic relationships, scores were assigned for microbial diversity and richness.

Results

Baseline analysis of contributing factors was performed in IBD participants in clinical remission, at study entry. This revealed a significant association between quality of life and health related QoL (r = 0.45, p < 0.001), with the latter also significantly and negatively associated with sleep quality (r = –0.40, p = 0.002). A significant negative relationship between psychological scores and health-related QoL (p < 0.001) was identified. There was a significant relationship between sleep quality and stress in the study cohort. There was no association between serum and stool immune biomarkers with sleep scores, psychological state, autonomic function or microbiome profile. Assessment of ANS function showed major bidirectional impact between baseline heart rate and heart rate during cognitive tasks (task 1; r = 0.925, p < 0.001 and task 2; r = 0.941, p < 0.001). There was no significant relationship between autonomic function and psychological states, or between ANS function and microbial diversity and richness. Similar microbial abundance at phylum level was identified in CD, UC and IBS, with the expected reduction in bacterial diversity in CD compared with IBS.

Conclusion

We showed baseline differences in microbiome, psychological state and sleep quality between CD, UC, and IBS. Assessing the interplay between all contributing factors revealed some significant associations suggesting underlying interaction between biological and psychological factors which were plausible and consistent with current literature. It will be important to examine the interplay between biopsychosocial factors in longitudinal analyses, in persistent remission and in relapse.