Gastrointestinal and liver disease in patients with schizophrenia: A narrative review

Table 1 Key recommendations

Gastrointestinal/liver disease	Recommendations
NAFLD	Regular monitoring of body mass index and triglycerides
	Encouragement of lifestyle modification
	Liver function tests performed and Fibrosis-4 scores calculated in all psychiatric inpatients and outpatients
Viral hepatitis	Routine screening for viral hepatitis during contact with mental health services
	Integrated approach between mental health, sexual health, substance misuse and specialist hepatology services
ALD	Integrated approach between mental health, substance misuse and hepatology
	Long term studies prospective studies required to fully comprehend burden of ALD
ALF	Clinicians prescribing clozapine should be aware of the potential risk of ALF and have a low threshold for checking liver enzymes and prothrombin time
	Psychiatric review of all patients presenting with POD
	For patients presenting with POD who have a pre-existing psychiatric diagnosis prompt communication must be made with community mental health teams, and appropriate follow-up arranged for those with a new diagnosis
	Decisions regarding liver transplant in patients with schizophrenia must involve the multidisciplinary team and be made on a patient-by-patient basis
PUD	Encouragement of lifestyle modification, particular smoking cessation and alcohol reduction
	Physicians to have a high suspicion for Helicobacter pylori infection
Coeliac disease	Large-scale studies amongst diverse population required
	Diagnosis to be considered in patients with schizophrenia presenting with malabsorption
Colorectal cancer	Supporting patients to participate in screening programmes and to attend follow-up appointments is key
IBD	Increased vigilance amongst clinicians regarding a potential diagnosis of IBD is central in enabling prompt diagnosis and maintenance of remission
IBS	Patients should be directly questioned concerning IBS symptoms when undergoing physical health review as many cases may go unrecognised
Clozapine induced constipation	Lifestyle advice to reduce risk
	Regular screening and escalation to GP/secondary care as appropriate
	Physicians to be aware of clozapine as potential cause of constipation and to discuss with psychiatry if considering dose adjustment/cessation

NAFLD: Non-alcoholic fatty liver disease; ALD: Alcohol related liver disease; ALF: Acute liver failure; POD: Paracetamol overdose; PUD: Peptic ulcer disease; IBD: Inflammatory bowel disease; IBS: Irritable bowel syndrome; GP: General practitioner.