An epidemiological study of Heyde's syndrome: an association between aortic stenosis and gastrointestinal bleeding

An association between aortic stenosis (AS) and gastrointestinal (GI) bleeding attributed to intestinal angiodysplasia has been termed Heyde's syndrome. Case-control studies of patients with AS or intestinal angiodysplasia assessing the degree of association have produced discrepant findings.

Data were examined for all patients discharged from public hospitals in the Republic of Ireland between 1997 and 2001 (3.8 million events) with a primary or secondary discharge diagnosis of AS (ICD-9-CM code 424.1), GI bleeding presumed due to intestinal angiodysplasia (ICD-9-CM codes 569.84, 569.85, 578.1, 578.9), or both. Proportions were compared using chi-squared testing.

There was a significant (p <0.0001) association between AS and GI bleeding, with an odds ratio of 4.5 (95% confidence interval 3.0-6.8). Age was a significant confounding factor; patients with both conditions were significantly older than patients with one or none of the conditions (p <0.0001). The incidence of GI bleeding in patients with AS was 0.9%, and the incidence of AS in patients with GI bleeding was 1.5%.

The results of this large retrospective analysis support the existence of an association between AS and GI bleeding presumed due to intestinal angiodysplasia. However, the percentage of patients with both conditions was low, and this may explain why some smaller studies have failed to demonstrate such an association.