Epidemiology and risk of psychiatric disorders among patients with celiac disease: A population-based national study
Corresponding Author
Motasem Alkhayyat
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Correspondence
Dr Motasem Alkhayyat, Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Email: [email protected]
Search for more papers by this authorThabet Qapaja
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Search for more papers by this authorManik Aggarwal
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Search for more papers by this authorAshraf Almomani
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Search for more papers by this authorMohammad Abureesh
Department of Internal Medicine, Staten Island University Hospital, New York City, New York, USA
Search for more papers by this authorOmaymah Al-otoom
University of Jordan Medical School, University of Jordan, Amman, Jordan
Search for more papers by this authorMohammad Zmaili
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Search for more papers by this authorEmad Mansoor
Department of Gastroenterology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Search for more papers by this authorMohannad Abou Saleh
Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Search for more papers by this authorCorresponding Author
Motasem Alkhayyat
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Correspondence
Dr Motasem Alkhayyat, Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Email: [email protected]
Search for more papers by this authorThabet Qapaja
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Search for more papers by this authorManik Aggarwal
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Search for more papers by this authorAshraf Almomani
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Search for more papers by this authorMohammad Abureesh
Department of Internal Medicine, Staten Island University Hospital, New York City, New York, USA
Search for more papers by this authorOmaymah Al-otoom
University of Jordan Medical School, University of Jordan, Amman, Jordan
Search for more papers by this authorMohammad Zmaili
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Search for more papers by this authorEmad Mansoor
Department of Gastroenterology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Search for more papers by this authorMohannad Abou Saleh
Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Search for more papers by this authorDeclaration of conflict of interest: There are no potential conflicts (financial, professional, or personal) to disclose by all the authors.
Author contribution: Motasem Alkhayyat, A. A., and M. A. S. contributed to the study conception and design. Motasem Alkhayyat, Manik Aggarawal, Mohammad Abureesh, T. Q., and M. Z. contributed to the acquisition of data. Motasem Alkhayyat, M. A. S., Mohammad Abureesh, and M. Z. analyzed and interpreted the data. Motasem Alkhayyat, T. Q., and Mohammad Abureesh drafted the manuscript. E. M. and M. A. S. critically revised the manuscript. Motasem Alkhayyat, M. A. S., and Manik Aggarawal performed the statistical analysis. E. M. and M. A. S. supervised the study.
Informed consent: Informed consent was waived; Explorys is HIPAA compliant database.
Financial support: None.
Abstract
Background and Aim
Celiac disease (CD) is a chronic disorder resulting from an immune reaction to gluten in genetically predisposed individuals. Although several studies have linked CD to psychiatric diseases, there are limited data on this topic. Using a large database, we sought to describe the epidemiology of several psychiatric disorders in CD.
Methods
We queried a multicenter database (Explorys Inc), an aggregate of electronic health record data from 26 major integrated healthcare systems from 2016 to 2020 consisting of 360 hospitals in the USA. A cohort of patients with a Systematized Nomenclature Of Medicine – Clinical Terms diagnosis of CD was identified. Multivariate analysis was performed using Statistical Package for Social Sciences version 25.
Results
Of the 37 465 810 patients in the database between 2016 and 2020, there were 112 340 (0.30%) individuals with CD. When compared with patients with no history of CD, patients with CD were more likely to have a history of anxiety (odds ratio [OR]: 1.385; 95% confidence interval [CI]: 1.364–1.407), depression (OR: 1.918; 95% CI: 1.888–1.947), bipolar (OR: 1.321; 95% CI: 1.289–1.354), attention-deficit hyperactivity disorder (OR: 1.753; 95% CI: 1.714–1.792), eating disorder (OR: 15.84; 95% CI: 15.533–16.154), and childhood autistic disorder (OR: 4.858; 95% CI: 3.626–6.508). Patients with CD and psychiatric conditions were more likely to be smokers, with history of alcohol and substance abuse as well as a history of personality disorder.
Conclusions
In this large database, patients with CD are at increased risk of having multiple psychiatric diseases including anxiety, depression, bipolar, attention-deficit hyperactivity disorder, eating disorder, and childhood autism. Individual care and referral to psychiatry when appropriate are warranted while taking care of this group of patients.
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