title: High risk of gastrointestinal hemorrhage in patients with epilepsy: a nationwide cohort study.
abstract: OBJECTIVE
  To examine the association between epilepsy and gastrointestinal hemorrhage.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yeh
authors.forename: Hwang-Huei
authors.initials: HH
authors.lastname: Wang
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chou
authors.forename: Chaur-Jong
authors.initials: CJ
authors.lastname: Hu
authors.forename: Wan-Hsin
authors.initials: WH
authors.lastname: Chou
authors.forename: Ta-Liang
authors.initials: TL
authors.lastname: Chen
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Liao
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000453:epidemiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: COPD; HR; ICD-9-CM; International Classification of Diseases, Ninth Revision, Clinical Modification; NSAID; TBI; chronic obstructive pulmonary disease; hazard ratio; nonsteroidal anti-inflammatory drug; traumatic brain injury