The association of peptic ulcer and schizophrenia: A population-based study
Introduction
Schizophrenia is a chronic and disabling psychiatric disorder with a worldwide prevalence of approximately 1% [1]. Patients with schizophrenia have been reported to have a higher mortality rate due to physical illness than the general population [2], [3], [4]. Although these patients have been reported to have a higher risk of several physical illnesses [5], [6], there are few reports about the association between schizophrenia and peptic ulcer, and these reports are not conclusive [7]. Peptic ulcer is a common digestive system disease with a prevalence of around 10–15% [8], [9]. There are multiple possible risk factors of peptic ulcer reported, including Helicobacter pylori (H. pylori) infection, alcohol, smoking and nonsteroidal anti-inflammatory drugs (NSAIDs) Schizophrenic patients were found to have a higher rate of H. pylori infection [10], which is one of the important factors contributing to peptic ulcer. They were also found to have a high prevalence of dyspepsia [11]. Schizophrenia patients also have higher risk of alcohol abuse and smoking [12], [13], [14], which could attribute to peptic ulcer. On the other hand, schizophrenia is caused partially by a hyperactivity of dopaminergic system [15]. Dopamine system was documented having a protective effect toward peptic ulcer [16], [17], [18], [19], [20]. There was an observational study based on in-patients' database showed that schizophrenia patients had lower risk than the general population [21]. The results was limited with the source of patients, which were included with in-patients. There has been little finding about the association between peptic ulcer and schizophrenia in the recent decades.
The incidence of peptic ulcer related to H. pylori infection has declined in recent decades [22], [23], but the risk of peptic ulcer among schizophrenic patients might be different. Besides, schizophrenia patients might take antipsychotic agents to control their psychotic symptoms. Antipsychotics included dopamine receptor antagonist, which might decrease the protective effect of dopamine agonist [24]. The aim of this study is to investigate the risk of peptic ulcer among patients with schizophrenia compared with the general population. Medications were considered as covariates in this study. In addition, this is the first population-based study to investigate peptic ulcer diagnosed by endoscopy among schizophrenic patients.
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Data sources and study subjects
The Taiwan National Health Insurance program, which covers over 23.03 million residents, or about 99.2% of the Taiwan population, was reformed on March 1, 1995, by the Bureau of National Health Insurance (BNHI). BNHI has released scrambled data to the National Health Research Institutes (NHRI) to establish 18 National Health Insurance Research Databases (NHIRDs) (http://w3.nhri.org.tw/nhird/date_01.html). The Longitudinal Health Insurance Database (LHID2000) we used in this study included all
Results
We sampled 7480 subjects in all, 1496 in the schizophrenia group and 5984 in the non-schizophrenia group. There were more male schizophrenic patients (males 55.0% vs. females 45.0%) and the mean age was 36.5 years (SD = 15.8). Compared with the non-schizophrenia group, schizophrenic patients lived in areas with lower urbanization, had lower income, and a higher prevalence of alcoholism, depression, bipolar, anxiety and received more medication (including antipsychotics, aspirin, lithium, valproate
Discussion
This population database cohort study demonstrated that there was a 1.27-fold increase in the incidence of peptic ulcer among schizophrenia patients than the non-schizophrenia patients in the matched control group. We did not find a significant association between schizophrenia and peptic ulcers after controlling the confounding factors. This suggests that the association between schizophrenia and peptic ulcer was influenced by multiple factors.
The incidence of peptic ulcer in schizophrenic
Author contributors
These authors' individual contributions were as follows. Conception and design: Chun-Hui Liao, Chen-Shu Chang, and Chia-Huang Kao; administrative support: Shih-Ni Chang, Chih-Hsin Muo, Hsien-Yuan Lane, and Fung-Chang Sung; collection and assembly of data: Chun-Hui Liao, Chen-Shu Chang, Shih-Ni Chang, and Chih-Hsin Muo; data analysis and interpretation: Chun-Hui Liao, Chen-Shu Chang, Shih-Ni Chang, and Chih-Hsin Muo; manuscript writing: all authors; final approval of manuscript: all authors.
Potential conflicts of interest
None of the authors has any conflict of interest to disclose. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
Funding/support
The present study was partly supported by the National Sciences Council (grant number NSC 100-2621-M-039-001), China Medical University Hospital (grant numbers 1MS1, DMR-96-080 and DMR-100-114), and Taiwan Ministry of Health and Welfare Clinical Trial and Research Center for Excellence (grant number MOHW103-TDU-B-212-113002). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding received for
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Chen-Shu Chang and Chun-Hui Liao contribute equally.