Grant RK, Brindle WM, Donnelly MC, McConville PM, Stroud TG, Bandieri L, Plevris JN. Gastrointestinal and liver disease in patients with schizophrenia: A narrative review. World J Gastroenterol 2022; 28(38): 5515-5529 [PMID: 36304087 DOI: 10.3748/wjg.v28.i38.5515]
Corresponding Author of This Article
Rebecca K Grant, BSc, MA, MBChB, MSc, The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, 51 Little France Cres, Old Dalkeith Rd, Edinburgh, EH16 4SA, United Kingdom. rebecca.x.grant@nhs.scot
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Gastroenterol. Oct 14, 2022; 28(38): 5515-5529 Published online Oct 14, 2022. doi: 10.3748/wjg.v28.i38.5515
Gastrointestinal and liver disease in patients with schizophrenia: A narrative review
Rebecca K Grant, William M Brindle, Mhairi C Donnelly, Pauline M McConville, Thomas G Stroud, Lorenzo Bandieri, John N Plevris
Rebecca K Grant, William M Brindle, Mhairi C Donnelly, John N Plevris, The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
Pauline M McConville, Thomas G Stroud, Lorenzo Bandieri, General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, United Kingdom
Author contributions: Grant RK and Brindle WM conceived the study; Grant RK performed the literature review and drafted all sections of the manuscript except for the section on acute liver failure; Donnelly MC performed the literature review and drafted the section on acute liver failure; Brindle WM, Donnelly MC, McConville PM, Stroud TG, and Bandieri L critically revised the manuscript; Plevris JN was senior author and critically revised the manuscript for important intellectual content.
Conflict-of-interest statement: There are no conflicts of interest to report.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rebecca K Grant, BSc, MA, MBChB, MSc, The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, 51 Little France Cres, Old Dalkeith Rd, Edinburgh, EH16 4SA, United Kingdom. rebecca.x.grant@nhs.scot
Received: July 18, 2022 Peer-review started: July 18, 2022 First decision: August 19, 2022 Revised: August 29, 2022 Accepted: September 21, 2022 Article in press: September 21, 2022 Published online: October 14, 2022
Abstract
Schizophrenia is a severe mental illness which can have a devastating impact on an individual’s quality of life. Comorbidities are high amongst patients and life expectancy is approximately 15 years less than the general population. Despite the well-known increased mortality, little is known about the impact of gastrointestinal and liver disease on patients with schizophrenia. We aimed to review the literature and to make recommendations regarding future care. Literature searches were performed on PubMed to identify studies related to gastrointestinal and liver disease in patients with schizophrenia. High rates of chronic liver disease were reported, with Non-Alcoholic Fatty Liver Disease being of particular concern; antipsychotics and metabolic syndrome were contributing factors. Rates of acute liver failure were low but have been associated with antipsychotic use and paracetamol overdose. Coeliac disease has historically been linked to schizophrenia; however, recent research suggests that a causal link is yet to be proven. Evidence is emerging regarding the relationships between schizophrenia and peptic ulcer disease, inflammatory bowel disease and irritable bowel syndrome; clinical vigilance regarding these conditions should be high. Patients with schizophrenia poorly engage with bowel cancer screening programmes, leading to late diagnosis and increased mortality. Clozapine induced constipation is a significant issue for many patients and requires close monitoring. There is a significant burden of gastrointestinal and liver disease amongst patients with schizophrenia. Better levels of support from all members of the medical team are essential to ensure that appropriate, timely care is provided.
Core Tip: We report significant rates of liver disease, particularly Non-alcoholic Fatty Liver Disease, in patients with schizophrenia, in addition to emerging evidence regarding the prevalence of lower gastrointestinal disease and peptic ulcer disease. We have clearly demonstrated the importance of a multidisciplinary approach to management and propose recommendations to ameliorate future care of this vulnerable group of patients.
