medwireNews: People with systemic sclerosis (SSc) are between two and three times more likely to experience gastrointestinal (GI) bleeding than people without the autoimmune condition, research carried out in Taiwan shows.
Ping-Hsun Wu and colleagues from Kaohsiung Medical University therefore believe that a “prevention strategy is needed for these high GI bleeding risk groups.”
The study included 3665 patients with SSc and 18,325 controls matched for age, sex, and year of diagnosis who were all identified from a national longitudinal health insurance database.
Overall, 5.2% of people with SSc and 3.7% of controls experienced GI bleeding during a mean 5.3 and 5.8 years of follow-up, respectively, giving corresponding incidence rates of 976.4 and 410.8 cases per 100,000 person–years.
More specifically, the incidence of upper GI bleeding was 591.8 versus 286.9 cases per 100,000 person–years in the SSc versus control groups, respectively, with corresponding rates of 423.0 versus 238.0 for peptic ulcer bleeding, 507.8 versus 169.5 for non-peptic ulcer bleeding, and 528.2 versus 167.1 for lower GI bleeding.
These findings showed that the GI bleeding risk was significantly higher for the people with SSc than for the controls, with incidence rate ratios (IRRs) of 2.38, 2.06, and 3.16 for overall, upper, and lower GI bleeding events, respectively. Among the upper GI bleeding outcomes, the IRRs for peptic and non-peptic ulcer bleeding were a corresponding 1.78 and 3.00.
Furthermore, multivariate analysis adjusted for age, sex, comorbidity, medication use, competing mortality, and time-dependent covariates revealed that SSc was significantly and independently associated with overall, upper, and lower GI bleeding risk, at hazard ratios (HR) of 2.98, 2.80, and 3.93, respectively.
In addition, the risks for both peptic and non-peptic ulcer bleeding were significantly higher with versus without SSc, at respective HRs of 2.52 and 3.57.
Other factors associated with increased GI bleeding risk included male sex, increased age, diabetes, hypertension, and the use of nonsteroidal anti-inflammatory drugs, antiplatelet therapy, and steroids.
Writing in Arthritis Research & Therapy, Wu and co-authors conclude that “[g]astroenterologists, rheumatologists, and primary health care providers should be aware of GI bleeding risk in SSc patients, and esophagogastroduodenoscopy and monitoring for GI complications should be considered.”
They add: “Among higher GI bleeding risks patients (male gender, elderly, diabetes, and hypertension), NSAIDs should be minimized or avoided in favor of acetaminophen or opiates.”
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