High risk of gastrointestinal hemorrhage in patients with systemic sclerosis
Yi-Ting Lin1,2,3, Yun-Shiuan Chuang1, Jiunn-Wei Wang2,4
1Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Insights
Systemic sclerosis (SSc) patients face a significantly higher risk of gastrointestinal (GI) bleeding events. This autoimmune disease increases the likelihood of both upper and lower GI bleeding, necessitating targeted prevention strategies.
Area of Science:
- Rheumatology
- Gastroenterology
- Epidemiology
Background:
- Systemic sclerosis (SSc) is a severe autoimmune disease impacting blood vessels.
- Gastrointestinal (GI) involvement is common in SSc, but GI bleeding risks are not well-defined.
- This study investigates the long-term GI bleeding risk in SSc patients.
Purpose of the Study:
- To determine the association between Systemic Sclerosis and the long-term risk of gastrointestinal bleeding.
- To analyze the risk for both upper and lower GI bleeding events in SSc patients.
- To identify SSc as an independent risk factor for GI bleeding.
Main Methods:
- Retrospective cohort study using Taiwanese health insurance databases (1998-2007).
- 3,665 SSc patients were matched with 18,325 SSc-free controls.
- Subdistribution hazards models were used to assess GI bleeding risk, adjusting for covariates.
Main Results:
- SSc patients had significantly higher incidence rate ratios for overall (2.38), upper (2.06), and lower (3.16) GI bleeding.
- SSc was an independent risk factor for overall (sHR 2.98), upper (sHR 2.80), and lower (sHR 3.93) GI bleeding events.
- The risk of GI bleeding was substantially elevated in SSc patients compared to controls.
Conclusions:
- Systemic sclerosis patients have a markedly increased risk of overall and specific types of GI bleeding.
- The findings highlight the need for proactive GI bleeding prevention strategies in SSc patients.
- SSc is confirmed as a significant independent risk factor for gastrointestinal bleeding.
Background:
Systemic sclerosis (SSc), a life-threatening autoimmune disease characterized by vasculopathy. Numerous SSc patients demonstrate gastrointestinal (GI) involvement but the delicate GI bleeding risk remains sparse. We aimed to explore the role of SSc in determining the long-term risk of GI bleeding, including bleedings of upper (peptic and non-peptic ulcers) and lower GI tracts.
Methods:
Patients with SSc diagnosis were identified from the Catastrophic Illness Patient Database and the National Health Insurance Research Database from 1998 to 2007. Each SSc patient was matched with five SSc-free individuals by age, sex, and index date. All individuals (case = 3665, control = 18,325) were followed until the appearance of a GI bleeding event, death, or end of 2008. A subdistribution hazards model was assessed to evaluate the GI bleeding risk with adjustments for age, sex, and time-dependent covariates, comorbidity, and medications.
Results:
The incidence rate ratios of GI bleeding were 2.38 (95% confidence interval [CI], 2.02-2.79), 2.06 (95% CI, 1.68-2.53), and 3.16 (95% CI, 2.53-3.96) for over-all, upper, and lower GI bleeding events in SSc patients. In the competing death risk in the subdistribution hazards model with time-covariate adjustment, SSc was an independent risk factor for over-all GI bleeding events (subdistribution hazard ratio [sHR] 2.98, 95% CI, 2.21-4.02), upper GI bleeding events (sHR 2.80, 95% CI, 1.92-4.08), and lower GI bleeding events (sHR 3.93, 95% CI, 2.52-6.13).
Conclusion:
SSc patients exhibited a significantly higher risk of over-all and different subtype GI bleeding events compared with the SSc-free population. The prevention strategy is needed for these high GI bleeding risk groups.
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