Depression in inflammatory bowel disease: risk factor, prodrome or extraintestinal manifestation? Reply from authors

We appreciate the thoughtful feedback and points raised by authors Moulton, Norton, Powell, Mohamedali and Hopkins regarding the temporality between depression and inflammatory bowel disease (IBD) diagnosis and recommendation to perform further sensitivity analyses.1 The authors correctly highlight that the prodromal effects of IBD, including fatigue and low mood, prior to diagnosis may mimic depression and therefore put temporality into question.2 Furthermore, the median time from Crohn’s disease symptom presentation to diagnosis is 9 months and 75% of patients are diagnosed within 2 years.3 In response, we have performed two sensitivity analyses restricting to observations with at least (1) 9 months between depression and IBD diagnosis and …