Small Bowel Vascular Lesions Are Associated with an Increased Risk of Subsequent Cardiovascular Disease After Small Bowel Bleeding.

Objective We evaluated the prognostic significance of small-bowel vascular lesions (SBVLs) by comparing the overall survival and cardiovascular disease (CVD) incidence in patients with and without SBVLs following small-bowel bleeding. Methods We retrospectively analyzed consecutive patients who underwent capsule endoscopy or double-balloon enteroscopy for suspected small bowel bleeding between January 2015 and September 2023. Patients with liver cirrhosis, Osler-Weber syndrome, or a follow-up period of <1 month were excluded. The patients were categorized into the SBVL-present and SBVL-absent groups. The baseline characteristics were compared, and cumulative survival and CVD incidence were assessed using the Kaplan-Meier method and Cox proportional hazards models. Results The cohort comprised 327 patients (188 men and 139 women; mean age, 71.5 years), of whom 95 (29%) had SBVLs. The SBVL-present group had a higher prevalence of smoking, hypertension, preexisting CVD, chronic kidney disease, and antiplatelet and proton pump inhibitor use. Over a median follow-up of 33 months, cumulative survival did not differ significantly between the groups (5-year survival: 73% vs. 83%, p=0.17), and no deaths were attributable to gastrointestinal bleeding. In contrast, the cumulative CVD incidence was significantly higher in the SBVL-present group (5-year incidence: 43% vs. 9%, p<0.01). The presence of SBVL was independently associated with an increased risk of CVD events (adjusted hazard ratio, 3.81; 95% confidence interval, 1.86-7.78). Conclusion SBVLs do not adversely affect overall survival, but are independently associated with a substantially increased risk of subsequent CVD events. Therefore, the detection of SBVLs may serve as a marker of systemic vascular vulnerability, warranting careful long-term cardiovascular surveillance.