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Depression and gastrointestinal disorders frequently occur together. UC Irvine experts wondered if knowing which tends to be diagnosed first could shed light on the well-established but not yet fully understood gut-brain connection.

Researchers analyzing large-scale electronic health records found a difference among three common conditions. Depression was typically diagnosed before irritable bowel syndrome. With Crohn's disease, the pattern was reversed, with the gastrointestinal disorder more often diagnosed first. Ulcerative colitis fell somewhere in between.

The findings add nuance to scientists' knowledge of the gut-brain axis and suggest that the relationship between mental and gastrointestinal health may differ with the ailment.

"IBS and Crohn's disease are fundamentally different diseases," says the study's corresponding author, Gha-Hyun Jeffrey Kim, Pharm.D., Ph.D., assistant professor of clinical pharmacy practice in UC Irvine's School of Pharmacy & Pharmaceutical Sciences and a member of the Robert A. Mah Molecular Innovation Center. "IBS involves changes in how the brain and gut communicate, including how gut signals are processed. That means problems on the brain side, like depression, can show up first and then shape what happens in the gut."

"In Crohn's disease, intestinal inflammation is the primary driver, and it reaches the brain through inflammatory signals and through the toll the disease takes on daily life," Kim says. "That fits the pattern we found. Crohn's disease was more often diagnosed before depression."

The study first examined records from 633,547 participants in the National Institutes of Health's All of Us Research Program, a national research cohort designed to include populations historically underrepresented in biomedical research.

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