Early-life gastrointestinal inflammation and the developing brain: Unravelling the pathways to long-term cognitive dysfunction

Table 8 Clinical Recommendations for screening and monitoring in gut-brain axis-related disorders

Domain of assessment	Rationale for screening	Relevant population	Key clinical outcome measures
Cognitive function	To identify deficits in processing speed, memory, and attention linked to systemic inflammation and micronutrient deficiencies (e.g., in IBD, CD)	NEC survivors, chronic IBD (adolescents/adults), CD	intelligence quotient tests (Wechsler Preschool and Primary Scale of Intelligence/Wechsler Intelligence Scale for Children), Reaction Time tests, Verbal/Visual Memory tests
Executive function	To detect impairments in planning, attention, and cognitive flexibility, commonly seen in active IBD and linked to frontal lobe dysfunction	Pediatric IBD (active disease), NEC survivors (attention deficits)	Trail Making Test, Stroop Color-Word Test, tests for perseverative errors (California Verbal Learning Test)
Mood/affective status	To address the high comorbidity of anxiety and depression in IBD and CD, which often mediates poor health-related quality of life	All chronic gastrointestinal patients (pediatric and adult)	Beck depression inventory, state-trait anxiety inventory, generalized anxiety disorder scale
Inflammatory markers	To correlate inflammation with cognitive status and assess the therapeutic target (i.e., deep healing)	IBD and CD patients	Plasma interleukin-6, fecal calprotectin, kynurenine-to-tryptophan ratio

It outlines specific neurocognitive, behavioral, and biological assessments required for high-risk patient populations with a history of severe early gastrointestinal disease (e.g., necrotizing enterocolitis, severe enteric infections) or chronic inflammatory conditions (e.g., inflammatory bowel disease, celiac disease). The recommendations emphasize a shift toward multidisciplinary, longitudinal monitoring to proactively identify and manage the subtle, yet persistent, cognitive and emotional deficits driven by chronic inflammation and malabsorption. CD: Celiac disease, IBD: Inflammatory bowel disease; NEC: Necrotizing enterocolitis.