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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Attention deficit hyperactivity disorder and gastrointestinal morbidity in a large cohort of young adults
Sivan Kedem, Shlomit Yust-Katz, Dan Carter, Zohar Levi, Ron Kedem, Adi Dickstein, Salah Daher, Lior H Katz
Sivan Kedem, Ron Kedem, Adi Dickstein, Salah Daher, Lior H Katz, Medical Corps, Israeli Defense Forces, Ramat-Gan 52621, Israel
Sivan Kedem, Medical School, Hebrew University - Hadassah Medical Center, Jerusalem 91120, Israel
Shlomit Yust-Katz, Dan Carter, Zohar Levi, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 77096, Israel
Shlomit Yust-Katz, Neuro-Oncology Unit, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva 49100, Israel
Dan Carter, Department of Gastroenterology, Sheba Medical Center, Ramat-Gan 52361, Israel
Zohar Levi, Department of Gastroenterology, Beilinson Hospital, Rabin Medical Center, Petach Tikva 49100, Israel
Salah Daher, Lior H Katz, Department of Gastroenterology and Hepatology, Hebrew University - Hadassah Medical Center, Jerusalem 91120, Israel
Author contributions: Kedem S was involved in data curation, investigation and analysis, and wrote the original draft; Yust-Katz S, Cater D was involved in the conceptualization and supervision of the study, and writing, review and editing of the manuscript; Levi Z was involved in data analysis, and writing, review and editing of the manuscript; Kedem R was involved in the investigation, data analysis and statistics, and writing, review and editing of the manuscript; Dickstein A was involved in data curation and investigation; Daher S was involved in project administration and supervision; Katz LH performed the conceptualization, was involved in data curation, investigation and analysis, project administration, and writing, review and editing of the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Conflict-of-interest statement: All the authors have no conflicts of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Lior H Katz, MD, Chairman, Doctor, Department of Gastroenterology and Hepatology, Hebrew University - Hadassah Medical Center, Ein-Kerem, Jerusalem 91120, Israel. liorkatz5346@gmail.com
Received: April 6, 2020
Peer-review started: April 6, 2020
First decision: April 26, 2020
Revised: July 3, 2020
Accepted: September 28, 2020
Article in press: September 28, 2020
Published online: November 14, 2020
BACKGROUND
Although the association of attention deficit hyperactivity disorder (ADHD) with psychiatric disorders is well known, its association with somatic diseases is unclear. Only few studies have investigated the gastrointestinal (GI) morbidity in adult patients with ADHD.
AIM
To measure gastrointestinal comorbidity and its burden on healthcare in young adults with ADHD.
METHODS
The cohort included subjects aged 17-35 years recruited to the Israel Defense Forces in 2007-2013, 33380 with ADHD and 355652 without (controls). The groups were compared for functional and inflammatory conditions of the gastrointestinal tract and clinic and specialist visits for gastrointestinal symptoms/disease during service (to 2016). Findings were analyzed by generalized linear models adjusted for background variables.
RESULTS
Compared to controls, the ADHD group had more diagnoses of functional gastrointestinal disorders (referred to as FGID), namely, dyspepsia [odds ratio (OR): 1.48, 95% confidence interval (CI): 1.40-1.57, P < 0.001], chronic constipation (OR: 1.64, 95%CI: 1.48-1.81, P < 0.001), and irritable bowel syndrome (OR: 1.67, 95%CI: 1.56-1.80, P < 0.001) but not of organic disorders (inflammatory bowel disease, celiac disease). They had more frequent primary care visits for gastrointestinal symptoms [rate ratio (RR): 1.25, 95%CI: 1.24-1.26, P < 0.001] and referrals to gastrointestinal specialists (RR: 1.96, 95%CI: 1.88-2.03, P < 0.001) and more episodes of recurrent gastrointestinal symptoms (RR: 1.29, 95%CI: 1.21-1.38, P < 0.001). Methylphenidate use increased the risk of dyspepsia (OR: 1.49, 95%CI: 1.28-1.73, P < 0.001) and constipation (OR: 1.42, 95%CI: 1.09-1.84, P = 0.009).
CONCLUSION
ADHD in young adults is associated with an excess of FGID and increased use of related health services. Research is needed to determine if an integrative approach treating both conditions will benefit these patients and cut costs.
Core Tip: The association of attention deficit hyperactivity disorder (ADHD) with gastrointestinal morbidity and gastrointestinal-associated healthcare burden is unclear. We measured it on a large cohort of young adults, containing 33380 subjects with ADHD and 355652 without. We showed for the first time that ADHD is associated with dyspepsia, chronic constipation, and irritable bowel syndrome but not with inflammatory bowel disease and celiac disease. Furthermore, young adults with ADHD have more frequent primary care visits for gastrointestinal symptoms and referrals to gastrointestinal specialists. ADHD in young adults is associated with an excess of functional gastrointestinal disorders and increased use of related health services.
