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Medicina Clínica (English Edition) Stress, microbiota, and the gut–brain axis in mental and digestive health
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Vol. 164. Issue 6.
Pages 295-304 (March 2025)
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Vol. 164. Issue 6.
Pages 295-304 (March 2025)
Review
Stress, microbiota, and the gut–brain axis in mental and digestive health
Estrés, microbiota y el eje intestino-cerebro en la salud mental y digestiva
Javier Santosa,b,c,
Corresponding author
, Patricia Laura Marand,e, Amanda Rodríguez-Urrutiad,e,f,g
a Gastroenterology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Hospital Campus, Barcelona, Spain
b Digestive Physiology and Physiopathology Research Group, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
c Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
d Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
e Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
f Treatment-Resistant Depression Programme, The Brain-Inmune-Gut Unit, Mental Health Department, Vall d’Hebron Hospital Campus, Barcelona, Spain
g Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Table 1. Summary of key theories, prevalence, shared pathophysiology, and clinical recommendations in the comorbidity of IBS, depression, and anxiety.
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Abstract

The prevailing mind-body dualism in contemporary medicine, rooted in reductionism and the fragmentation of knowledge, has impeded the development of a conceptual model that can adequately address the complexity of illnesses. Integrating biomedical data into a cohesive model that considers the mind–body–context interconnections is essential. This integration is not merely theoretical; rather, it has significant clinical implications. This is exemplified by chronic stress-related mental and digestive disorders. The onset and development of these disorders are intimately linked to chronic psychological stress via the brain–gut–microbiota axis. The present article examines the evidence and mechanisms indicating that stress is a primary factor and a potentiator of symptom severity in common mental health and digestive diseases, with a particular focus on human studies. However, due to space limitations, only a very general overview of preventive and therapeutic clinical strategies is provided. It is hoped that the recurring phrase, “Everything that happens to you is due to stress,” will become more comprehensible to the physician after reading this manuscript.

Keywords:
Brain–gut
Microbiome
Stress
Inflammation
Neuroimmune activation
Anxiety
Depression
Digestive disorders
Resumen

El dualismo mente-cuerpo imperante en la medicina contemporánea, arraigado en el reduccionismo y la fragmentación del conocimiento, ha impedido el desarrollo de un modelo conceptual para abordar adecuadamente la complejidad de las enfermedades. Es esencial integrar los datos biomédicos en un modelo cohesivo que considere las interconexiones mente-cuerpo. La aparición y el desarrollo de los trastornos mentales y digestivos relacionados con el estrés crónico están íntimamente ligados al eje cerebro-intestino-microbiota. Este artículo examina las evidencias y los mecanismos que indican que el estrés es un factor primario y un potenciador de la gravedad de los síntomas en enfermedades mentales y digestivas comunes, con especial atención a los estudios en humanos. Sin embargo, debido a las limitaciones de espacio, solo se ofrece una visión muy general de las estrategias clínicas preventivas y terapéuticas. Esperamos que la frase recurrente «Lo que te está pasando se debe al estrés» resulte más comprensible para el médico tras la lectura de este manuscrito.

Palabras clave:
Cerebro-intestino
Microbioma
Estrés
Inflamación
Activación neuroinmune
Ansiedad
Depresión
Trastornos digestivos

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