High risk of gastrointestinal hemorrhage in patients with Epilepsy: A nationwide cohort study

Chun Chieh Yeh, Hwang Huei Wang, Yi Chun Chou, Chaur Jong Hu, Wan Hsin Chou, Ta Liang Chen, Chien Chang Liao

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Abstract

Objective: To examine the association between epilepsy and gastrointestinal hemorrhage. Patients and Methods: We conducted a nationwide retrospective cohort study by using data from Taiwan's National Health Insurance Research Database. Patients 20 years and older newly diagnosed as having epilepsy and nonepileptic adults were identified between January 1, 2000, and December 31, 2003, and were observed through December 31, 2008. Cox proportional hazards models were performed to calculate adjusted hazard ratios (HRs) and 95% CIs of gastrointestinal hemorrhage associated with epilepsy. Results: Compared with the nonepileptic group (n=449,541), epileptic patients (n=1412) had a higher incidence of gastrointestinal hemorrhage (13.4 vs 2.9 per 1000 person-years), with an HR of 2.97 (95% CI, 2.49-3.53). The HRs of gastrointestinal hemorrhage for patients with generalized epilepsy, inpatient care, emergency care, and frequent outpatient visits for epilepsy were 3.50 (95% CI, 2.59-4.72), 3.96 (95% CI, 2.85-5.50), 4.35 (95% CI, 3.15-6.01), and 4.96 (95% CI, 3.97-6.21), respectively. Risks were significantly higher in epileptic patients with mental disorders (HR, 3.20; 95% CI, 2.55-4.01), aged 70 years and older (HR, 4.08; 95% CI, 2.89-5.77), and in the first year after epilepsy (HR, 4.81; 95%, CI, 3.14-7.34). Conclusion: Epilepsy is an independent determinant for gastrointestinal hemorrhage in a chronological and severity-dependent pattern. We urge the development of an adequate surveillance policy and strategy for the early prevention of gastrointestinal hemorrhage in epileptic patients.

Original languageEnglish
Pages (from-to)1091-1098
Number of pages8
JournalMayo Clinic Proceedings
Volume88
Issue number10
DOIs
Publication statusPublished - Oct 2013

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Gastrointestinal Hemorrhage
Epilepsy
Cohort Studies
Generalized Epilepsy
National Health Programs
Emergency Medical Services
Taiwan
Proportional Hazards Models
Mental Disorders
Inpatients
Outpatients
Retrospective Studies
Databases
Incidence
Research

ASJC Scopus subject areas

  • Medicine(all)

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High risk of gastrointestinal hemorrhage in patients with Epilepsy : A nationwide cohort study. / Yeh, Chun Chieh; Wang, Hwang Huei; Chou, Yi Chun; Hu, Chaur Jong; Chou, Wan Hsin; Chen, Ta Liang; Liao, Chien Chang.

In: Mayo Clinic Proceedings, Vol. 88, No. 10, 10.2013, p. 1091-1098.

Research output: Contribution to journalArticle

Yeh, Chun Chieh ; Wang, Hwang Huei ; Chou, Yi Chun ; Hu, Chaur Jong ; Chou, Wan Hsin ; Chen, Ta Liang ; Liao, Chien Chang. / High risk of gastrointestinal hemorrhage in patients with Epilepsy : A nationwide cohort study. In: Mayo Clinic Proceedings. 2013 ; Vol. 88, No. 10. pp. 1091-1098.
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abstract = "Objective: To examine the association between epilepsy and gastrointestinal hemorrhage. Patients and Methods: We conducted a nationwide retrospective cohort study by using data from Taiwan's National Health Insurance Research Database. Patients 20 years and older newly diagnosed as having epilepsy and nonepileptic adults were identified between January 1, 2000, and December 31, 2003, and were observed through December 31, 2008. Cox proportional hazards models were performed to calculate adjusted hazard ratios (HRs) and 95{\%} CIs of gastrointestinal hemorrhage associated with epilepsy. Results: Compared with the nonepileptic group (n=449,541), epileptic patients (n=1412) had a higher incidence of gastrointestinal hemorrhage (13.4 vs 2.9 per 1000 person-years), with an HR of 2.97 (95{\%} CI, 2.49-3.53). The HRs of gastrointestinal hemorrhage for patients with generalized epilepsy, inpatient care, emergency care, and frequent outpatient visits for epilepsy were 3.50 (95{\%} CI, 2.59-4.72), 3.96 (95{\%} CI, 2.85-5.50), 4.35 (95{\%} CI, 3.15-6.01), and 4.96 (95{\%} CI, 3.97-6.21), respectively. Risks were significantly higher in epileptic patients with mental disorders (HR, 3.20; 95{\%} CI, 2.55-4.01), aged 70 years and older (HR, 4.08; 95{\%} CI, 2.89-5.77), and in the first year after epilepsy (HR, 4.81; 95{\%}, CI, 3.14-7.34). Conclusion: Epilepsy is an independent determinant for gastrointestinal hemorrhage in a chronological and severity-dependent pattern. We urge the development of an adequate surveillance policy and strategy for the early prevention of gastrointestinal hemorrhage in epileptic patients.",
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N2 - Objective: To examine the association between epilepsy and gastrointestinal hemorrhage. Patients and Methods: We conducted a nationwide retrospective cohort study by using data from Taiwan's National Health Insurance Research Database. Patients 20 years and older newly diagnosed as having epilepsy and nonepileptic adults were identified between January 1, 2000, and December 31, 2003, and were observed through December 31, 2008. Cox proportional hazards models were performed to calculate adjusted hazard ratios (HRs) and 95% CIs of gastrointestinal hemorrhage associated with epilepsy. Results: Compared with the nonepileptic group (n=449,541), epileptic patients (n=1412) had a higher incidence of gastrointestinal hemorrhage (13.4 vs 2.9 per 1000 person-years), with an HR of 2.97 (95% CI, 2.49-3.53). The HRs of gastrointestinal hemorrhage for patients with generalized epilepsy, inpatient care, emergency care, and frequent outpatient visits for epilepsy were 3.50 (95% CI, 2.59-4.72), 3.96 (95% CI, 2.85-5.50), 4.35 (95% CI, 3.15-6.01), and 4.96 (95% CI, 3.97-6.21), respectively. Risks were significantly higher in epileptic patients with mental disorders (HR, 3.20; 95% CI, 2.55-4.01), aged 70 years and older (HR, 4.08; 95% CI, 2.89-5.77), and in the first year after epilepsy (HR, 4.81; 95%, CI, 3.14-7.34). Conclusion: Epilepsy is an independent determinant for gastrointestinal hemorrhage in a chronological and severity-dependent pattern. We urge the development of an adequate surveillance policy and strategy for the early prevention of gastrointestinal hemorrhage in epileptic patients.

AB - Objective: To examine the association between epilepsy and gastrointestinal hemorrhage. Patients and Methods: We conducted a nationwide retrospective cohort study by using data from Taiwan's National Health Insurance Research Database. Patients 20 years and older newly diagnosed as having epilepsy and nonepileptic adults were identified between January 1, 2000, and December 31, 2003, and were observed through December 31, 2008. Cox proportional hazards models were performed to calculate adjusted hazard ratios (HRs) and 95% CIs of gastrointestinal hemorrhage associated with epilepsy. Results: Compared with the nonepileptic group (n=449,541), epileptic patients (n=1412) had a higher incidence of gastrointestinal hemorrhage (13.4 vs 2.9 per 1000 person-years), with an HR of 2.97 (95% CI, 2.49-3.53). The HRs of gastrointestinal hemorrhage for patients with generalized epilepsy, inpatient care, emergency care, and frequent outpatient visits for epilepsy were 3.50 (95% CI, 2.59-4.72), 3.96 (95% CI, 2.85-5.50), 4.35 (95% CI, 3.15-6.01), and 4.96 (95% CI, 3.97-6.21), respectively. Risks were significantly higher in epileptic patients with mental disorders (HR, 3.20; 95% CI, 2.55-4.01), aged 70 years and older (HR, 4.08; 95% CI, 2.89-5.77), and in the first year after epilepsy (HR, 4.81; 95%, CI, 3.14-7.34). Conclusion: Epilepsy is an independent determinant for gastrointestinal hemorrhage in a chronological and severity-dependent pattern. We urge the development of an adequate surveillance policy and strategy for the early prevention of gastrointestinal hemorrhage in epileptic patients.

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