High risk of gastrointestinal hemorrhage in patients with epilepsy: a nationwide cohort study Outstanding Poster Award

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 non-epileptic 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% confidence intervals (CIs) of gastrointestinal hemorrhage associated with epilepsy.Results: Compared with the 449541 non-epileptic people, 1412 epileptic patients 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 a determinant for gastrointestinal hemorrhage in a severity-dependent pattern. We urge an adequate surveillance for the early prevention of gastrointestinal hemorrhage in epileptic patients.