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Multicenter Study
. 2021 May;45(3):101521.
doi: 10.1016/j.clinre.2020.07.025. Epub 2020 Aug 14.

Upper gastrointestinal bleeding in COVID-19 inpatients: Incidence and management in a multicenter experience from Northern Italy

Aurelio Mauro  1 , Federico De Grazia  2 , Marco Vincenzo Lenti  3 , Roberto Penagini  4 , Roberto Frego  5 , Sandro Ardizzone  6 , Edoardo Savarino  7 , Franco Radaelli  8 , Matteo Bosani  9 , Stefania Orlando  10 , Arnaldo Amato  8 , Marco Dinelli  5 , Francesca Ferretti  6 , Elisabetta Filippi  4 , Maurizio Vecchi  4 , Davide Stradella  10 , Marco Bardone  2 , Lodovica Pozzi  2 , Laura Rovedatti  2 , Elena Strada  2 , Antonio Di Sabatino  3
Affiliations
Multicenter Study

Upper gastrointestinal bleeding in COVID-19 inpatients: Incidence and management in a multicenter experience from Northern Italy

Aurelio Mauro et al. Clin Res Hepatol Gastroenterol. 2021 May.

Abstract

Background: COVID-19 patients have an increased susceptibility to develop thrombotic complications, thus thromboprophylaxis is warranted which may increase risk of upper gastrointestinal bleeding (UGIB). Our aim was to evaluate incidence of UGIB and use of upper GI endoscopy in COVID-19 inpatients.

Methods: The medical and endoscopic management of UGIB in non-ICU COVID-19 patients has been retrospectively evaluated. Glasgow Blatchford score was calculated at onset of signs of GI bleeding. Timing between onset of signs of GI bleeding and execution, if performed, of upper GI endoscopy was evaluated. Endoscopic characteristics and outcome of patients were evaluated overall or according to the execution or not of an upper GI endoscopy before and after 24h.

Results: Out of 4871 COVID-19 positive patients, 23 presented signs of UGIB and were included in the study (incidence 0.47%). The majority (78%) were on anticoagulant therapy or thromboprophylaxis. In 11 patients (48%) upper GI endoscopy was performed within 24h, whereas it was not performed in 5. Peptic ulcer was the most common finding (8/18). Mortality rate was 21.7% for worsening of COVID-19 infection. Mortality and rebleeding were not different between patients having upper GI endoscopy before or after 24h/not performed. Glasgow Blatchford score was similar between the two groups (13;12-16 vs 12;9-15).

Conclusion: Upper GI bleeding complicated hospital stay in almost 0.5% of COVID-19 patients and peptic ulcer disease is the most common finding. Conservative management could be an option in patients that are at high risk of respiratory complications.

Keywords: COVID-19; Peptic ulcer; Upper gastrointestinal bleeding.

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Figures

Figure 1
Figure 1
Peptic ulcer with visible vessel (Forrest IIa) on the anterior wall of duodenal bulb (on the left) treated with epinephrine injection and one hemostatic clip, Olympus HX-610-090 (on the right).
Figure 2
Figure 2
Diffuse antral erosive gastritis with superficial ulcers on the lesser wall.
Figure 3
Figure 3
Proposed algorithm for the management of upper gastrointestinal bleeding in COVID-19 positive patients.
See this image and copyright information in PMC

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