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. 2021 Nov;9(9):1081-1090.
doi: 10.1002/ueg2.12165. Epub 2021 Oct 15.

Gastrointestinal bleeding and endoscopic findings in critically and non-critically ill patients with corona virus disease 2019 (COVID-19): Results from Lean European Open Survey on SARS-CoV-2 (LEOSS) and COKA registries

Stephan Zellmer  1 , Frank Hanses  2   3 , Anna Muzalyova  1 , Johanna Classen  1 , Georg Braun  1 , Christiane Piepel  4 , Johanna Erber  5 , Lisa Pilgram  6 , Lorenz Walter  7 , Siri Göpel  8 , Kai Wille  9 , Martin Hower  10 , Maria Madeleine Rüthrich  11 , Jan Rupp  12 , Christian Degenhardt  13 , Ingo Voigt  14 , Stefan Borgmann  15 , Melanie Stecher  16   17 , Carolin Jakob  16   17 , Christine Dhillon  18 , Helmut Messmann  1 , Alanna Ebigbo  1 , Christoph Römmele  1   18 ; LEOSS study group
Affiliations

Gastrointestinal bleeding and endoscopic findings in critically and non-critically ill patients with corona virus disease 2019 (COVID-19): Results from Lean European Open Survey on SARS-CoV-2 (LEOSS) and COKA registries

Stephan Zellmer et al. United European Gastroenterol J. 2021 Nov.

Abstract

Background: Corona virus disease 2019 (COVID-19) patients are at increased risk for thromboembolic events. It is unclear whether the risk for gastrointestinal (GI) bleeding is also increased.

Methods: We considered 4128 COVID-19 patients enrolled in the Lean European Open Survey on SARS-CoV-2 (LEOSS) registry. The association between occurrence of GI bleeding and comorbidities as well as medication were examined. In addition, 1216 patients from COKA registry were analyzed focusing on endoscopy diagnostic findings.

Results: A cumulative number of 97 patients (1.8%) with GI bleeding were identified in the LEOSS registry and COKA registry. Of 4128 patients from the LEOSS registry, 66 patients (1.6%) had a GI bleeding. The rate of GI bleeding in patients with intensive care unit (ICU) admission was 4.5%. The use of therapeutic dose of anticoagulants showed a significant association with the increased incidence of bleeding in the critical phase of disease. The Charlson comorbidity index and the COVID-19 severity index were significantly higher in the group of patients with GI bleeding than in the group of patients without GI bleeding (5.83 (SD = 2.93) vs. 3.66 (SD = 3.06), p < 0.01 and 3.26 (SD = 1.69) vs. 2.33 (SD = 1.53), p < 0.01, respectively). In the COKA registry 31 patients (2.5%) developed a GI bleeding. Of these, the source of bleeding was identified in upper GI tract in 21 patients (67.7%) with ulcer as the most frequent bleeding source (25.8%, n = 8) followed by gastroesophageal reflux (16.1%, n = 5). In three patients (9.7%) GI bleeding source was located in lower GI tract caused mainly by diverticular bleeding (6.5%, n = 2). In seven patients (22.6%) the bleeding localization remained unknown.

Conclusion: Consistent with previous research, comorbidities and disease severity correlate with the incidence of GI bleeding. Also, therapeutic anticoagulation seems to be associated with a higher risk of GI bleeding. Overall, the risk of GI bleeding seems not to be increased in COVID-19 patients.

Keywords: COVID-19; GI bleeding; LEOSS; SARS-CoV-2; critically ill.

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Conflict of interest statement

All authors declare that they have no conflict of interest.

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