Brain-gut co-management: probiotic LAB improves mental health and further reduces disease activity in ulcerative colitis patients with emotional disturbance

Objectives Patients with Ulcerative Colitis (UC) are susceptible to emotional disturbance, which could negatively affect the condition itself. Meanwhile, certain probiotics have been proven to alleviate emotional disturbance, and improve disease status in UC. Yet little is known about probiotic's efficacy on UC patients with emotional disturbance.Methods Sixty patients were recruited, diagnosed as having mild to moderate UC and with anxiety and/or depression disorders. Participants were then randomly assigned to a control group receiving conventional treatment (mesalazine ≤4 g) or a probiotic group receiving probiotic LAB combined with conventional treatment for 8 weeks. At the commencement and conclusion of the study, questionnaires were administered to determine patients’ improvements in emotional disturbance and disease activity. Stool samples were collected concurrently to estimate alterations in fecal microbiota.Results At 8 weeks, 65.4% of patients in the probiotic group had relieved anxiety disorder, compared to 34.6% in the control group (p = 0.03). Improvement on depression was higher in the probiotic group (53.8%) than the control group (30.8%), though without significant differences (p = 0.09). Both groups had reduced Modified Mayo Scores (MMS). Mayo Endoscopic Sub-score (MES) dropped significantly in the probiotic group (p = 0.02) but not in the control group. Fecal samples sequenced by 16S rRNA showed a significant increase in Firmicutes after receiving probiotics, and no significant differences were detected in the control group.Discussion This randomized trial demonstrated that supplementation with probiotic LAB could restore the abundance of Firmicutes, improve anxiety disorder, and reduce MES in UC patients with emotional disturbance.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT04006977, date October 2019.