The Epidemiology of Gastrointestinal Bleeding in Patients with Amyloidosis

Abstract

Abstract Introduction Gastrointestinal amyloidosis is most prevalent in the upper gastrointestinal tract and colorectum with gastrointestinal hemorrhage as the presenting symptom in 25–45% of patients. There is limited epidemiologic data on the overall prevalence of gastrointestinal hemorrhage in patients with amyloidosis. Methods/Aims The aim of this study was to investigate the association between amyloidosis and risk of gastrointestinal hemorrhage at the population level. Data was collected from a commercial database (Explorys Inc, Cleveland, OH), between 12/2016-12/2021. We identified patients with amyloidosis and compared prevalence of gastrointestinal bleeding sources at least 30 days post-amyloidosis diagnosis to a control cohort without amyloidosis. Results We identified 17,350 cases of amyloidosis. In those with amyloidosis, there were 1,270 cases of gastrointestinal hemorrhage. The prevalence of gastrointestinal hemorrhage in patients with amyloidosis was 7320/100000 persons and the prevalence in patients without amyloidosis was 3565/100000 persons. Odds ratio for development of any gastrointestinal hemorrhage after at least 30 days was 2.05 (95% CI 1.95–2.17, p < 0.001), for upper gastrointestinal hemorrhage was 2.59 (95% CI 2.35–2.85, p < 0.001), and for lower gastrointestinal hemorrhage was 1.66 (95% CI 1.54–1.79, p < 0.001). Colon angiodysplasias were the most frequent sources of gastrointestinal hemorrhage followed by intestinal angiodysplasias, gastric ulcers, and duodenal ulcers. Conclusions In this large population-based study, GIB was significantly more prevalent in patients with amyloidosis compared to those without amyloidosis over a 5-year period.