Introduction: There is a higher rate of co-morbid psychiatric illnesses in patients with inflammatory bowel disease (IBD) compared to the general population. The literature on the association and impact of generalized anxiety disorder (GAD) on IBD remains limited. The primary aim of our study was to assess the outcomes and the risk of complications in patients with IBD and GAD. Methods: We performed a retrospective analysis in the IBM Explorys database (1999-2021), a pooled, national, de-identified clinical database of over 72 million unique patients from 26 health care networks and 300 hospitals. IBD patients were identified by a diagnosis of either ulcerative colitis (UC) or Crohn’s disease (CD) who had a gastroenterology provider plus any one IBD medication. GAD patients were identified by the diagnosis code of GAD plus any anti-depressant medication or class. Exclusion criteria included the following: cerebrovascular accident, lupus, rheumatoid arthritis, myocardial infarction, multiple sclerosis, diabetes, psoriasis, malignancy, alcohol/substance abuse, epilepsy, hypo/hyperthyroidism and fibromyalgia. Control group included non-IBD patients who had GAD. IBD outcomes evaluated were as follows: disease flare, biologic therapy, colon cancer, strictures, fistula, pouchitis, osteoporosis, malnutrition, and IBD surgery. These outcomes were compared in IBD patients with GAD and those without GAD. Odds ratio with 95% CI were calculated to assess risk of GAD and complications in UC or CD compared to control cohort. Results: A total of 49,090 patients were identified with a diagnosis of UC, of which 2,070 (4.22%) also had GAD. 62,480 patients were identified with CD, of which 3,270 (4.22%) had GAD. Patients with CD (OR 3.34, 95% CI 3.22–3.46, P < 0.0001) and UC (2.69, 2.58–2.81) were at a higher risk of GAD compared to control cohort. Patients with UC and GAD were at a higher risk for disease flare (1.53, 1.41-1.65), pouchitis (1.31, 1.12-1.53), and malnutrition (1.75, 1.52-2.02) when compared to control cohort (Figure 1). Patients with CD and GAD were at a higher risk for disease flare (1.47, 1.38-1.56) and malnutrition (1.85, 1.67-2.05) compared to control cohort (Figure 1). Conclusion: A diagnosis of GAD is more commonly present with IBD, with increased risk of UC/CD flares and malnutrition when compared to the general IBD population. This study highlights the importance for gastroenterologists to screen and address GAD in their IBD clinics as it may significantly impact the natural course of the disease.Figure 1.: Odds ratios with 95% confidence intervals of inflammatory bowel disease (UC and CD) outcomes and complications in patients with and without generalized anxiety disorder (GAD).Table 1.: Comparing baseline demographics in Ulcerative Colitis (UC) and Crohn’s Disease (CD) patients with generalized anxiety disorder (GAD) to those without GAD