Akash Khurana, MD1, Syed Ahmad Adil, MD2, Mohammed Z. Sheriff, MD3, Gregory Cooper, MD3 1University Hospitals of Cleveland, Cleveland, OH; 2University Hospitals/CMC, Cleveland, OH; 3University Hospitals Digestive Health Institute, Cleveland, OH
Introduction: Amyloidosis is characterized by deposition of insoluble protein fibrils in the extracellular space. Gastrointestinal (GI) amyloidosis commonly results from infiltration of the mucosal lining and is most prevalent in the upper GI tract and colorectum. Hence, gastrointestinal hemorrhage (GIB) is the presenting symptom in 25-45% of patients with GI amyloidosis. However, limited epidemiologic data exists on the overall prevalence of GIB in patients with amyloidosis.
Methods: The aim of this study was to investigate if amyloidosis is associated with increased overall risk of GIB and to report the specific etiologies of GIB in these cases. Data was collected from a commercial database (Explorys Inc, Cleveland, OH), an aggregate of EHR data from 27 integrated healthcare systems in the US between 12/2016-12/2021. We identified patients with amyloidosis based on Systemized Nomenclature of Medicine – Clinical Terms. We compared the prevalence of GIB sources at least 30 days post-amyloidosis diagnosis to a control cohort without amyloidosis.
Results: Of the 34,063,760 patients, we identified 17,350 cases of amyloidosis. There were 1,270 cases of GIB in patients with amyloidosis. The overall prevalence with and without amyloidosis was 7320/100000 persons and 3565/100000 persons, respectively. The overall prevalence ratio (PR) of developing GIB after at least 30 days of a diagnosis of amyloidosis was 2.05 (95% CI, 1.95-2.17, p< 0.001). Table 1 shows different causes of GIB. The overall prevalence of upper gastrointestinal hemorrhage (UGIB) with and without amyloidosis was 2306/100000 persons and 890/100000 persons, respectively. The overall prevalence ratio of developing UGIB at least 30 days post-amyloidosis diagnosis was 2.59 (95% CI, 2.35-2.85, P< 0.001). The overall prevalence of lower gastrointestinal hemorrhage (LGIB) with and without amyloidosis was 3804/100000 persons and 2295/100000 persons, respectively. The overall prevalence ratio of developing LGIB at least 30 days post-amyloidosis diagnosis was 1.66 (95% CI, 1.54-1.79, p< 0.001). Table 2 shows different GIB etiologies sub-categorized by demographics.
Discussion: 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.
Figure: Table 1. Prevalence and prevalence ratios of different etiologies of GIB in patients with and without amyloidosis.
Table 2. Prevalence ratios of etiologies of GIB in patients with amyloidosis categorized by demographic characteristics. (*format is PR, 95% CI, p-value)
Disclosures:
Akash Khurana indicated no relevant financial relationships.
Syed Ahmad Adil indicated no relevant financial relationships.
Mohammed Sheriff indicated no relevant financial relationships.
Gregory Cooper indicated no relevant financial relationships.
Akash Khurana, MD1, Syed Ahmad Adil, MD2, Mohammed Z. Sheriff, MD3, Gregory Cooper, MD3. E0296 - Prevalence of Gastrointestinal Hemorrhage in Patients With Amyloidosis: A Population-Based Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
