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. 2022;1(4):487-499.
doi: 10.1016/j.gastha.2022.02.021. Epub 2022 Mar 10.

Clinical and Endoscopic Outcomes in Coronavirus Disease-2019 Patients With Gastrointestinal Bleeding

Hassan Ashktorab  1 , Tiziano Russo  1 , Gholamreza Oskrochi  2 , Giovanni Latella  3 , Sara Massironi  4 , Martina Luca  4 , Lakshmi G Chirumamilla  1 , Adeyinka O Laiyemo  1 , Hassan Brim  1
Affiliations

Clinical and Endoscopic Outcomes in Coronavirus Disease-2019 Patients With Gastrointestinal Bleeding

Hassan Ashktorab et al. Gastro Hep Adv. 2022.

Abstract

Background and aims: Over 404 million people worldwide have been infected with coronavirus disease-2019 (COVID-19), 145 million in the United States (77 million) and Europe (151 million) alone (as of February 10, 2022). This paper aims to analyze data from studies reporting gastrointestinal bleeding (GIB) and/or endoscopic findings in COVID-19 patients in Western countries.

Methods: We conducted a systematic review of articles on confirmed COVID-19 cases with GIB in Western countries published in PubMed and Google Scholar databases from June 20, 2020, to July 10, 2021.

Results: A total of 12 studies reporting GIB and/or endoscopic findings in 808 COVID-19 patients in Western countries were collected and analyzed. Outcomes and comorbidities were compared with 18,179 non-GIB COVID-19 patients from Italy and the United States. As per our study findings, the overall incidence of GIB in COVID-19 patients was found to be 0.06%. When compared to the non-GIB cohort, the death rate was significantly high in COVID-19 patients with GIB (16.4% vs 25.4%, P < .001, respectively). Endoscopic treatment was rarely necessary, and blood transfusion was the most common GIB treatment. The most common presentation in GIB patients is melena (n = 117, 47.5%). Peptic, esophageal, and rectal ulcers were the most common endoscopic findings in upper (48.4%) and lower (36.4%) endoscopies. The GIB cohort had worse outcomes and higher incidence of hypertension (61.1%), liver disease (11.2%), and cancer (13.6%) than the non-GIB cohort. Death was strongly associated with hypertension (P < .001, r = 0.814), hematochezia (P < .001, r = 0.646), and esophagogastroduodenoscopy (P < .001, r = 0.591) in COVID-19 patients with GIB.

Conclusions: Overall, the incidence of GIB in COVID-19 patients is similar to that estimated in the overall population, with melena being the most common presentation. The common endoscopic findings in GIB COVID-19 patients were ulcers, esophagitis, gastritis, and colitis. Patients with GIB were more prone to death than non-GIB COVID-19 patients.

Keywords: ACE2, angiotensin-converting enzyme 2; COVID-19, coronavirus disease–2019; Coronavirus Disease-19; EGD, esophagogastroduodenoscopy; Endoscopy; GI, gastrointestinal; GIB, gastrointestinal bleeding; Gastrointestinal Bleeding; Hematemesis; ICU, intensive care unit; Melena; UGIB, upper GIB.

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Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Clinical manifestations/reason for endoscopy in the GIB patients with COVID-19.
Figure 3
Figure 3
Endoscopic gastrointestinal findings in the GIB patients. (A) Upper gastrointestinal findings in the GIB patients. (B) Lower gastrointestinal (LGI) findings in the GIB patients.
Figure 4
Figure 4
Nonsurgical treatments for gastrointestinal bleeding in patients with COVID-19.
Figure 5
Figure 5
Comparing comorbidities, outcomes, and respiratory support between GIB and non-GIB COVID-19 patients. (A) Differences in comorbidities among the GIB and non-GIB patients. (B) Differences in respiratory support and outcomes among GIB and non-GIB COVID-19 patients.
See this image and copyright information in PMC

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