Kedem Sivan, Yust-Katz Shlomit, Carter Dan, Levi Zohar, Kedem Ron, Dickstein Adi, Daher Salah, Katz Lior H
Medical Corps, Israeli Defense Forces, Ramat-Gan 52621, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 77096, Israel.
World J Gastroenterol. 2020 Nov 14;26(42):6626-6637. doi: 10.3748/wjg.v26.i42.6626.
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.
To measure gastrointestinal comorbidity and its burden on healthcare in young adults with ADHD.
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
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, < 0.001], chronic constipation (OR: 1.64, 95%CI: 1.48-1.81, < 0.001), and irritable bowel syndrome (OR: 1.67, 95%CI: 1.56-1.80, < 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, < 0.001] and referrals to gastrointestinal specialists (RR: 1.96, 95%CI: 1.88-2.03, < 0.001) and more episodes of recurrent gastrointestinal symptoms (RR: 1.29, 95%CI: 1.21-1.38, < 0.001). Methylphenidate use increased the risk of dyspepsia (OR: 1.49, 95%CI: 1.28-1.73, < 0.001) and constipation (OR: 1.42, 95%CI: 1.09-1.84, = 0.009).
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.
尽管注意力缺陷多动障碍（ADHD）与精神疾病的关联已广为人知，但其与躯体疾病的关联尚不清楚。仅有少数研究调查了成年ADHD患者的胃肠道发病率。
测量年轻ADHD患者的胃肠道合并症及其对医疗保健的负担。
该队列包括2007年至2013年应征加入以色列国防军的17至35岁受试者，其中33380名患有ADHD，355652名未患ADHD（对照组）。比较两组胃肠道的功能和炎症状况，以及服役期间（至2016年）因胃肠道症状/疾病进行的门诊和专科就诊情况。通过对背景变量进行调整的广义线性模型分析研究结果。
与对照组相比，ADHD组功能性胃肠疾病（称为FGID）的诊断更多，即消化不良[优势比（OR）：1.48，95%置信区间（CI）：1.40 - 1.57，P < 0.001]、慢性便秘（OR：1.64，95%CI：1.48 - 1.81，P < 0.001）和肠易激综合征（OR：1.67，95%CI：1.56 - 1.80，P < 0.001），但器质性疾病（炎症性肠病、乳糜泻）的诊断无差异。他们因胃肠道症状进行的初级保健就诊更频繁[率比（RR）：1.25，95%CI：1.24 - 1.26，P < 0.001]，转诊至胃肠专科医生的次数更多（RR：1.96，95%CI：1.88 - 2.03，P < 0.001），反复出现胃肠道症状的发作次数更多（RR：1.29，95%CI：1.21 - 1.38，P < 0.001）。使用哌甲酯会增加消化不良（OR：1.49，95%CI：1.28 - 1.73，P < 0.001）和便秘（OR：1.42，95%CI：1.09 - 1.84，P = 0.009）的风险。
年轻成人ADHD与FGID过多及相关医疗服务使用增加有关。需要开展研究以确定综合治疗这两种疾病的方法是否会使这些患者受益并降低成本。
