Share：
Share this content in WeChat
X
[Chinese] [PDF] 66 1
• Review •
Research progress on MRI of the comorbidity between depression and gastrointestinal abnormalities
LIU Juan  XU Wanze  ZHANG Xiaoyi  LIANG Feifei  LI Jing  DOU Yu 

DOI:10.12015/issn.1674-8034.2026.07.020.


[Abstract] Major depressive disorder (MDD) is a leading cause of psychological and physical disability worldwide and a major contributor to the global disease burden. MDD is highly comorbid with gastrointestinal (GI) abnormalities, and patients with GI symptoms (GI-MDD) exhibit more severe clinical profiles than those without (NGI-MDD), particularly with respect to suicidality and anxiety. The neurobiological mechanisms underlying this comorbidity are complex and likely involve multifaceted interactions along the brain-gut axis. Advances in neuroimaging and MRI have opened new avenues for exploring the neural correlates and mechanistic links between MDD and GI disturbances. However, current MRI studies are largely limited by cross-sectional designs, small sample sizes, and insufficient adjustment for confounding factors. In addition, the integration of multi-omics data with multimodal neuroimaging remains scarce, which constrains efforts to clarify the causal architecture of bidirectional brain-gut interactions. This review synthesizes current MRI evidence on structural, functional, and network-level brain alterations in GI-MDD, and further extends the scope to neuroimaging findings in functional gastrointestinal disorders and inflammatory bowel disease with comorbid depression. From a brain-gut axis perspective, we highlight shared and distinct central alterations across these conditions and critically appraise key methodological limitations in the literature. Finally, we outline future directions, including longitudinal designs, large-scale multi-center validation, and integrative approaches incorporating microbiome and metabolomics data. These efforts may ultimately deepen our mechanistic understanding of the comorbidity and inform clinical decision-making, prognostic assessment, and the design of future investigations.
[Keywords] gastrointestinal abnormalities；depression；magnetic resonance imaging；brain structure；brain function；brain network；brain-gut axis

LIU Juan1, 2   XU Wanze1, 2   ZHANG Xiaoyi1, 2   LIANG Feifei1, 2   LI Jing1, 2   DOU Yu2*  

1 The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China

2 Department of Radiology, the First Hospital of Lanzhou University, Lanzhou 730000, China

Corresponding author: DOU Y, E-mail: douy@lzu.edu.cn

Conflicts of interest   None.

Received  2026-03-24
Accepted  2026-07-08
DOI: 10.12015/issn.1674-8034.2026.07.020
DOI:10.12015/issn.1674-8034.2026.07.020.

[1]
MONROE S M, HARKNESS K L. Major Depression and Its Recurrences: Life Course Matters[J]. Annu Rev Clin Psychol, 2022, 18: 329-357. DOI: 10.1146/annurev-clinpsy-072220-021440.
[2]
YANG K S, WANG X Q, SHEN Y, et al. Research on the mechanism of resting-state functional magnetic resonance imaging in major depressive disorder complicated with sleep disturbances[J]. Chin J Magn Reson Imaging, 2026, 17(2): 1-6, 30. DOI: 10.12015/issn.1674-8034.2026.02.001.
[3]
JIANG Y, CHENG J L, CHEN Y, et al. The changes of functional connectivity on hemispheric level in depression patients with suicidal ideation: A functional magnetic resonance imaging study[J]. Chin J Magn Reson Imaging, 2022, 13(4): 1-4, 14. DOI: 10.12015/issn.1674-8034.2022.04.001.
[4]
YU R, LIU N, LIAO K K, et al. Alterations in gray matter structure in adolescents with non-suicidal self-injury comorbid with depressive disorder[J]. Chin J Magn Reson Imaging, 2024, 15(12): 73-78. DOI: 10.12015/issn.1674-8034.2024.12.011.
[5]
ILLIUS S, EDER J, VOGEL S, et al. The predictive value of polygenic risk scores for depression in gene-environment interaction studies: a systematic review[J/OL]. Transl Psychiatry, 2026, 16(1) [2026-03-24]. https://www.nature.com/articles/s41398-025-03793-7. DOI: 10.1038/s41398-025-03793-7.
[6]
TIAN P, ZOU R, WANG L, et al. Multi-Probiotics ameliorate Major depressive disorder and accompanying gastrointestinal syndromes via serotonergic system regulation[J]. J Adv Res, 2023, 45: 117-125. DOI: 10.1016/j.jare.2022.05.003.
[7]
OH T K, SONG I A. Psychiatric disorders and the burden of chronic gastrointestinal diseases: Evidence from a nationwide cross-sectional study[J/OL]. J Psychosom Res, 2026, 202: 112512 [2026-03-24]. https://doi.org/10.1016/j.jpsychores.2025.112512. DOI: 10.1016/j.jpsychores.2025.112512.
[8]
GAO Y, DING B, MENG Y, et al. Depressive Symptoms Trajectories and Chronic Digestive Disease in Chinese Middle-Aged and Older Adults: A Longitudinal Cohort Study[J/OL]. J Prev (2022), 2026 [2026-03-24]. https://link.springer.com/article/10.1007/s10935-026-00901-1. DOI: 10.1007/s10935-026-00901-1.
[9]
HUANG X, LAI S, LU X, et al. Cognitive dysfunction and neurometabolic alternations in major depressive disorder with gastrointestinal symptoms[J]. J Affect Disord, 2023, 322: 180-186. DOI: 10.1016/j.jad.2022.10.036.
[10]
JEONG C K, KIM D J, YOON S H, et al. Investigating the Gut-Brain Axis in Adolescents With Mood Disorders and Functional Gastrointestinal Symptoms[J]. Psychiatry Investig, 2026, 23(3): 345-352. DOI: 10.30773/pi.2025.0366.
[11]
KOCHAR B, BARNES E L, LONG M D, et al. Depression Is Associated With More Aggressive Inflammatory Bowel Disease[J]. Am J Gastroenterol, 2018, 113(1): 80-85. DOI: 10.1038/ajg.2017.423.
[12]
NING H Y, LIU Y W, QIAO L J, et al. Research progress of magnetic resonance imaging in thalamus of major depressive disorder[J]. Chin J Magn Reson Imaging, 2025, 16(9): 174-180. DOI: 10.12015/issn.1674-8034.2025.09.026.
[13]
TAE W S, HAM B J, PYUN S B, et al. Current Clinical Applications of Structural MRI in Neurological Disorders[J]. J Clin Neurol, 2025, 21(4): 277-293. DOI: 10.3988/jcn.2025.0185.
[14]
XIE Y X, ZHANG T J. Research progresses of resting-state functional MRI on brain white matter networks in neuropsychiatric diseases[J]. Chin J Med Imaging Technol, 2025, 41(3): 486-489. DOI: 10.13929/j.issn.1003-3289.2025.03.029.
[15]
ZHAI Y, XU J, ZHANG Z, et al. Neuroimaging-genetic integration reveals shared structural and functional brain alterations in major depressive disorder[J/OL]. J Affect Disord, 2026, 395(Pt A): 120700 [2026-03-24]. https://www.sciencedirect.com/science/article/pii/S0165032725021421?via%3Dihub. DOI: 10.1016/j.jad.2025.120700.
[16]
LIU P, LI G, ZHANG A, et al. Brain structural and functional alterations in MDD patient with gastrointestinal symptoms: A resting-state MRI study[J]. J Affect Disord, 2020, 273: 95-105. DOI: 10.1016/j.jad.2020.03.107.
[17]
LIU P H, LI Y, ZHANG A X, et al. Brain structural alterations in MDD patients with gastrointestinal symptoms: Evidence from the REST-meta-MDD project[J/OL]. Prog Neuropsychopharmacol Biol Psychiatry, 2021, 111: 110386 [2026-03-24]. https://www.sciencedirect.com/science/article/pii/S0278584621001457?via%3Dihub. DOI: 10.1016/j.pnpbp.2021.110386.
[18]
KOC N A, RAKOWSKI M, DĘBSKA A, et al. Theoretical, Technical, and Analytical Foundations of Task-Based and Resting-State Functional Magnetic Resonance Imaging (fMRI)-A Narrative Review[J/OL]. Biomedicines, 2026, 14(2): 333 [2026-03-24]. https://www.mdpi.com/2227-9059/14/2/333. DOI: 10.3390/biomedicines14020333.
[19]
BISWAL B B, UDDIN L Q. The history and future of resting-state functional magnetic resonance imaging[J]. Nature, 2025, 641(8065): 1121-1131. DOI: 10.1038/s41586-025-08953-9.
[20]
FU X, LI H, YAN M, et al. Shared and Distinct Fractional Amplitude of Low-Frequency Fluctuation Patterns in Major Depressive Disorders With and Without Gastrointestinal Symptoms[J/OL]. Front Psychiatry, 2021, 12: 744898 [2026-03-24]. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.744898/full. DOI: 10.3389/fpsyt.2021.744898.
[21]
YAN M, CHEN J, LIU F, et al. Disrupted Regional Homogeneity in Major Depressive Disorder With Gastrointestinal Symptoms at Rest[J/OL]. Front Psychiatry, 2021, 12: 636820 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC8187583/. DOI: 10.3389/fpsyt.2021.636820.
[22]
LIU Y, OU Y, ZHAO J, et al. Abnormal interhemispheric homotopic functional connectivity is correlated with gastrointestinal symptoms in patients with major depressive disorder[J]. J Psychiatr Res, 2021, 144: 234-240. DOI: 10.1016/j.jpsychires.2021.10.016.
[23]
LIU M, FAN G, MENG L, et al. New perspectives on microbiome-dependent gut-brain pathways for the treatment of depression with gastrointestinal symptoms: from bench to bedside[J]. J Zhejiang Univ Sci B, 2025, 26(1): 1-25. DOI: 10.1631/jzus.B2300343.
[24]
KANG Y, JUNG J, HAN K M, et al. Resting-state functional connectivity of the fronto-limbic and default mode network as neural correlates of antidepressant response in major depressive disorder[J/OL]. J Affect Disord, 2025, 394(Pt B): 120607 [2026-03-24]. https://www.sciencedirect.com/science/article/pii/S016503272502049X?via%3Dihub. DOI: 10.1016/j.jad.2025.120607.
[25]
LIU Q, YANG X, ZHANG H M, et al. Application of brain network and transcranial magnetic stimulation in depressive symptoms[J]. Chin J Rehabil Med, 2025, 40(6): 962-967. DOI: 10.3969/j.issn.1001-1242.2025.06.025.
[26]
YAN M, FU X, OU Y, et al. Multiple-Network Alterations in Major Depressive Disorder With Gastrointestinal Symptoms at Rest Revealed by Global Functional Connectivity Analysis[J/OL]. Front Neurosci, 2022, 16: 897707 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC9263397/. DOI: 10.3389/fnins.2022.897707.
[27]
YAN M, CHEN J, LIU F, et al. Abnormal Default Mode Network Homogeneity in Major Depressive Disorder With Gastrointestinal Symptoms at Rest[J/OL]. Front Aging Neurosci, 2022, 14: 804621 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC9009333/. DOI: 10.3389/fnagi.2022.804621.
[28]
DING Y, OU Y, YAN H, et al. Disrupted Cerebellar-Default Mode Network Functional Connectivity in Major Depressive Disorder With Gastrointestinal Symptoms[J/OL]. Front Cell Neurosci, 2022, 16: 833592 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC8927069/. DOI: 10.3389/fncel.2022.833592.
[29]
FU X, DING Y, CHEN J, et al. Altered Brain Functional Asymmetry in Patients With Major Depressive Disorder Related to Gastrointestinal Symptoms[J/OL]. Front Neurosci, 2021, 15: 797598 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC8891942/. DOI: 10.3389/fnins.2021.797598.
[30]
QI L, ZHANG T, PAN X, et al. A neural signature for gastrointestinal symptoms in depression: insula-gastric connectivity predicts symptom severity[J/OL]. Front Psychiatry, 2025, 16: 1672148 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC12673926/. DOI: 10.3389/fpsyt.2025.1672148.
[31]
LOPETUSO L R, MURGIANO M, MANTUANO E, et al. The Molecular Landscape of Inflammation in Inflammatory Bowel Disease (IBD): Targets for Precision Medicine[J/OL]. Biomedicines, 2025, 13(11): 2738 [2026-03-24]. https://www.mdpi.com/2227-9059/13/11/2738. DOI: 10.3390/biomedicines13112738.
[32]
KARAIVAZOGLOU K, AGGELETOPOULOU I, TRIANTOS C. Interoceptive Processing in Functional Gastrointestinal Disorders[J/OL]. Int J Mol Sci, 2024, 25(14): 7633 [2026-03-24]. https://www.mdpi.com/1422-0067/25/14/7633. DOI: 10.3390/ijms25147633.
[33]
LI J, YUAN B, LI G, et al. Convergent syndromic atrophy of pain and emotional systems in patients with irritable bowel syndrome and depressive symptoms[J/OL]. Neurosci Lett, 2020, 723: 134865 [2026-03-24]. https://www.sciencedirect.com/science/article/pii/S030439402030135X?via%3Dihub. DOI: 10.1016/j.neulet.2020.134865.
[34]
CHEN X F, GUO Y, LU X Q, et al. Aberrant Intraregional Brain Activity and Functional Connectivity in Patients With Diarrhea-Predominant Irritable Bowel Syndrome[J/OL]. Front Neurosci, 2021, 15: 721822 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC8446353/. DOI: 10.3389/fnins.2021.721822.
[35]
SUN Q, XIONG N, WANG Y, et al. Shared and distinct aberrations in frontal-striatal system functional patterns among patients with irritable bowel syndrome and major depressive disorder[J]. J Affect Disord, 2024, 362: 391-403. DOI: 10.1016/j.jad.2024.07.005.
[36]
LI J, HE P, LU X, et al. A Resting-state Functional Magnetic Resonance Imaging Study of Whole-brain Functional Connectivity of Voxel Levels in Patients With Irritable Bowel Syndrome With Depressive Symptoms[J]. J Neurogastroenterol Motil, 2021, 27(2): 248-256. DOI: 10.5056/jnm20209.
[37]
TANG R, JIN Y, XU K, et al. Aberrant functional connectivity patterns in the pregenual anterior cingulate cortex and anterior midcingulate cortex of patients with irritable bowel syndrome accompanied by depressive symptoms[J]. Brain Imaging Behav, 2025, 19(2): 279-290. DOI: 10.1007/s11682-024-00964-w.
[38]
DUAN S, LIU L, LI G, et al. Altered Functional Connectivity Within and Between Salience and Sensorimotor Networks in Patients With Functional Constipation[J/OL]. Front Neurosci, 2021, 15: 628880 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC7991789/. DOI: 10.3389/fnins.2021.628880.
[39]
LI G, ZHANG W, HU Y, et al. Distinct Basal Brain Functional Activity and Connectivity in the Emotional-Arousal Network and Thalamus in Patients With Functional Constipation Associated With Anxiety and/or Depressive Disorders[J]. Psychosom Med, 2021, 83(7): 707-714. DOI: 10.1097/psy.0000000000000958.
[40]
HU Y, JIA Z, ZHANG L, et al. White-matter microstructural alterations in patients with functional constipation: A tract-based spatial statistics study[J/OL]. Neurogastroenterol Motil, 2022, 34(5): e14338[2026-03-24]. https://onlinelibrary.wiley.com/doi/10.1111/nmo.14338. DOI: 10.1111/nmo.14338.
[41]
YIN Y, MA M, LIU H, et al. Brain-Gut Communication in Crohn's Disease: Insights From MRI Into Psychological Problems[J]. J Magn Reson Imaging, 2026, 63(1): 22-38. DOI: 10.1002/jmri.70029.
[42]
HARTMANN H A, BERTHOLD M L, RAMKIRAN S, et al. Shared neurobiological changes in individuals with Crohn's disease and major depressive disorder[J/OL]. Commun Med (Lond), 2025, 5(1): 388 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC12443968/. DOI: 10.1038/s43856-025-01117-w.
[43]
KANO M, DUPONT P, AZIZ Q, et al. Understanding Neurogastroenterology From Neuroimaging Perspective: A Comprehensive Review of Functional and Structural Brain Imaging in Functional Gastrointestinal Disorders[J]. J Neurogastroenterol Motil, 2018, 24(4): 512-527. DOI: 10.5056/jnm18072.
[44]
FELDMAN M J, BLISS-MOREAU E, LINDQUIST K A. The neurobiology of interoception and affect[J]. Trends Cogn Sci, 2024, 28(7): 643-661. DOI: 10.1016/j.tics.2024.01.009.
[45]
CRITCHLEY H D, PATCHITT J. Interoception, Insula, and Autonomic Integration: Relevance to the Expression and Treatment of Psychiatric Symptoms[J]. Curr Top Behav Neurosci, 2025, 70: 63-85. DOI: 10.1007/7854_2024_518.
[46]
KANDILAROVA S, NAJAR D, VELKOV N, et al. Neuroimaging aspects of interception in mood disorders: A systematic review[J]. J Affect Disord, 2025, 368: 686-694. DOI: 10.1016/j.jad.2024.09.125.
[47]
BRASSARD S L, LIU H, DOSANJH J, et al. Neurobiological foundations and clinical relevance of effort-based decision-making[J]. Brain Imaging Behav, 2024, 18(5): 1-30. DOI: 10.1007/s11682-024-00890-x.
[48]
MYERS D C, SIMON J, OH J, et al. Circuit-Based Approaches to Understanding the Anterior Cingulate Cortex (ACC)[J/OL]. J Neurosci, 2025, 45(46): e1311252025[2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC12614063/. DOI: 10.1523/jneurosci.1311-25.2025.
[49]
GENG H, XU P, ALEMAN A, et al. Dynamic Organization of Large-scale Functional Brain Networks Supports Interactions Between Emotion and Executive Control[J]. Neurosci Bull, 2024, 40(7): 981-991. DOI: 10.1007/s12264-023-01168-w.
[50]
REISIAN M, TOBEN C, CIOBANU L G, et al. A systematic review of associations between functional connectivity, mood and cognition in patients with irritable bowel syndrome[J/OL]. Brain Imaging Behav, 2026, 20(2) [2026-03-24]. https://link.springer.com/article/10.1007/s11682-026-01135-9. DOI: 10.1007/s11682-026-01135-9.
[51]
BALAJEWICZ B, SZUKALSKA S, KARCZEWSKA M, et al. The Role of Oxytocin and Cortisol as Biomarkers of Efficacy in Animal-Assisted Interventions for Patients With Major Depressive Disorder: A Narrative Review[J/OL]. Cureus, 2026, 18(2): e103217[2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC12974984/. DOI: 10.7759/cureus.103217.
[52]
SCHIWECK C, DALILE B, BALLIET A, et al. Circulating short chain fatty acids are associated with depression severity and predict remission from major depressive disorder[J/OL]. Brain Behav Immun Health, 2025, 48: 101070 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC12320157/. DOI: 10.1016/j.bbih.2025.101070.
[53]
MORENA D, LIPPI M, SCOPETTI M, et al. Leaky Gut Biomarkers as Predictors of Depression and Suicidal Risk: A Systematic Review and Meta-Analysis[J/OL]. Diagnostics (Basel), 2025, 15(13): 1683 [2026-03-24]. https://www.mdpi.com/2075-4418/15/13/1683. DOI: 10.3390/diagnostics15131683.
[54]
BAYKAN O, AKBAS F, SOLMAZ AVCIKURT A, et al. Bipolar and major depressive disorders: associations with serum zonulin levels and rs2070937 polymorphism[J/OL]. BMC Psychiatry, 2025, 25(1): 1086 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC12613481/. DOI: 10.1186/s12888-025-07548-y.
[55]
QIAN Y, CHEN Y, LIU L, et al. Depression and anxiety in inflammatory bowel disease: mechanisms and emerging therapeutics targeting the microbiota-gut-brain axis[J/OL]. Front Immunol, 2025, 16: 1676160 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC12634526/. DOI: 10.3389/fimmu.2025.1676160.
[56]
BARRERA FLORES F J, TAMEZ J A G, WINKELMAN T, et al. A multidisciplinary approach to the management of disorders of gut-brain interaction: psychopharmacology, psychotherapy, and diet[J/OL]. Front Gastroenterol (Lausanne), 2025, 4: 1637172 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC12885561/. DOI: 10.3389/fgstr.2025.1637172.
[57]
ZHU Z, CHENG Y, LIU X, et al. The microbiota-gut-brain axis in depression: unraveling the relationships and therapeutic opportunities[J/OL]. Front Immunol, 2025, 16: 1644160 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC12507892/. DOI: 10.3389/fimmu.2025.1644160.
[58]
LIN K, SUNKO D, WANG J, et al. Investigating the relationship between hippocampus/dentate gyrus volume and hypothalamus metabolism in participants with major depressive disorder[J/OL]. Sci Rep, 2024, 14(1): 10622 [2026-03-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC11082185/. DOI: 10.1038/s41598-024-61519-z.
[59]
KANG Y, SHIN D, KIM A, et al. Resting-state functional connectivity is correlated with peripheral inflammatory markers in patients with major depressive disorder and healthy controls[J]. J Affect Disord, 2025, 370: 207-216. DOI: 10.1016/j.jad.2024.11.017.

PREV Advances in structural and functional MRI studies of deep nuclei in Parkinson<sup><sup>,</sup></sup>s disease patients
NEXT Advances in MRI and radiomics for pituitary neuroendocrine tumors under the new WHO classification
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn