Psychological distress links to magnetic resonance enterography abnormalities in Crohn’s disease

Abstract Objectives Emerging evidence underscores psychological distress as a potential modifier of clinical outcomes in Crohn’s disease (CD), though its etiological basis remains undetermined. This study investigated associations between psychological distress and intestinal abnormalities identified by magnetic resonance enterography (MRE) through serum neurotransmitter analysis. Materials and methods In this prospective study, 105 patients with CD and 46 healthy controls (HCs) completed the State-Trait Anxiety Inventory (including the STAI-Trait and State scores), the Beck Depression Inventory, and the Perceived Stress Scale to assess psychological distress. CD patients underwent MRE and serum neurotransmitter profiling. 79 patients received repeat MRE and psychological evaluations during follow-up. Statistical analyses included correlation analysis, multivariable logistic regression, and Cox proportional hazards modeling. Results CD patients exhibited higher psychological distress scores vs. HCs (all p < 0.001). Anxiety severity (STAI-Trait score) correlated with CD bowel stricture, perienteric effusion, mural T2WI hyperintensity and hyperenhancement (| r | =0.454–0.606; all p < 0.05). Multivariable analysis showed that STAI-Trait score influenced the odds of perienteric effusion (OR = 1.124, 95% CI 1.007, 1.255, p = 0.036). Longitudinal follow-up demonstrated significantly higher incidence of new-onset perienteric effusion in patients with elevated baseline STAI-Trait scores compared to those with low scores (62.1% vs. 15.4%, p < 0.001), with STAI-Trait being the strongest predictor (HR = 6.986, 95% CI 2.274, 21.465, p < 0.001). Both STAI-Trait score and perienteric effusion showed consistent associations with serum tryptophan and histidine levels (| r | =0.203–0.255; all p < 0.05). Conclusion CD patients’ psychological state is associated with intestinal morphological changes on MRE. The associations of serum tryptophan and histidine levels with both psychological distress and MRE features provide preliminary support for gut-brain interaction in CD. Critical relevance statement This study links psychological distress to macro-morphological intestinal changes detectable by MRE, potentially associated with neurotransmitters like tryptophan, thereby advancing our understanding of the emotional factors associated with gut pathophysiology in CD and underscoring the importance of integrated psychological and inflammatory monitoring. Key Points Psychological distress correlates with clinical outcomes in patients with Crohn’s disease, but the reason for this association remains largely unexplored. Psychological distress is associated with macro-morphological changes as detected in MR enterography, blood tryptophan and histidine, and longitudinal follow-up further explains this connection. This study provides additional evidence for improving the management of both psychological well-being and intestinal inflammation in patients with Crohn’s disease. Graphical Abstract