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However, their association with bleeding disorders, anaemia and the impact of hormone replacement therapy is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To investigate the risk of liver and gastrointestinal diseases, haemorrhage and anaemia in women with Turner syndrome compared with the female background population, and the long\u2010term impact of hormone replacement therapy on these conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>One thousand one hundred and fifty\u2010six women with Turner syndrome diagnosed during 1960\u20102014 were identified using the Danish Cytogenetic Central Registry and linked with personal\u2010level data from the National Patient Registry and the Medication Statistics Registry. Statistics Denmark randomly identified 115\u00a0577 age\u2010matched female controls. Negative binomial regression was used to analyse hospital discharge diagnoses. Medical prescriptions, mortality and the effect of hormone replacement therapy were estimated using stratified Cox regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Liver disease increased 13\u2010fold (IRR 12.9 (95% CI 5.8\u201028.8)), due to toxic liver disease (IRR 8.0 (95% CI 1.8\u201035.4)), liver insufficiency (IRR 6.7 (95% CI 1.7\u201026.9)), fibrosis\/cirrhosis (IRR 16.5 (95% CI 2.2\u2010122.1)) and unspecified liver disease (IRR 10.6 (95% CI 4.4\u201025.3)). Furthermore, presence of abnormal liver enzymes increased 12\u2010fold (IRR 12.4 (95% CI 4.2\u201036.6)). The risk of gastrointestinal haemorrhage (IRR 3.4 (95% CI 1.8\u20106.2)), anaemia (IRR 3.2 (95% CI 2.0\u20105.0)) and coagulation disorders (IRR 2.9 (95% CI 1.1\u20107.1)) was increased. However these diagnoses were not associated with inflammatory bowel disease. Gastrointestinal mortality was increased three\u2010fold (HR 3.1 (95% CI 1.5\u20106.2)), partly due to death by liver disease (HR 3.0 (95% CI 1.1\u20108.2)), gastrointestinal haemorrhage (HR 29.6 (95% CI 3.1\u2010285.1)) and capillary malformations (HR 18.6 (95% CI 4.1\u201085.0)). There was no effect of hormone replacement therapy on gastrointestinal risk but a trend towards a beneficial impact on liver diseases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The risk of being diagnosed with liver disease was higher than previously reported. The occurrence of gastrointestinal haemorrhage and anaemia was increased in Turner syndrome. There was no effect of hormone replacement therapy on gastrointestinal risk but a trend towards a beneficial impact on liver diseases was detected.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.16277","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T06:30:15Z","timestamp":1693549815000},"page":"821-829","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Increased occurrence of liver and gastrointestinal diseases and anaemia in women with Turner syndrome \u2013 a nationwide cohort study"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6574-4893","authenticated-orcid":false,"given":"Mette Hansen","family":"Viuff","sequence":"first","affiliation":[{"name":"Department of Molecular Medicine Aarhus University Hospital Aarhus Denmark"},{"name":"Department of Internal Medicine and Endocrinology Aarhus University Hospital Aarhus 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