Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis
Umair Iqbal1, Hafsa Anwar2, Hafiz Umair Siddiqui3
1Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA.
Insights
COVID-19 patients with gastrointestinal bleeding (GIB) often respond well to conservative management. Interventions like endoscopy or embolization are best reserved for unstable patients or those unresponsive to initial treatment, showing low GIB mortality and rebleeding risks.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Critical Care Medicine
Background:
- The COVID-19 pandemic has impacted over 100 million individuals globally.
- Patients diagnosed with COVID-19 exhibit an increased susceptibility to bleeding complications.
- Acute gastrointestinal bleeding (GIB) is a significant concern in COVID-19 patients.
Purpose of the Study:
- To systematically review and meta-analyze the outcomes of COVID-19 patients presenting with acute GIB.
- To evaluate the efficacy of different management strategies for GIB in the context of COVID-19.
Main Methods:
- A comprehensive literature search was conducted across major databases (Embase, MEDLINE, Web of Science, Cochrane Library) up to November 11, 2020.
- Studies focusing on COVID-19 patients with signs and symptoms of GIB were included.
- Data from eight selected studies involving 127 patients were pooled for analysis.
Main Results:
- Conservative management was employed in 59% of cases, with endoscopic evaluation in 31.5% and interventional radiology (IR) embolization in 11%.
- Peptic ulcer disease was the most frequent endoscopic finding (47.5%).
- The pooled overall mortality rate was 19.1%, with a GIB-specific mortality of 3.5%. The pooled risk of rebleeding was 11.3%.
Conclusions:
- A majority of COVID-19 patients with GIB demonstrated positive responses to conservative treatment.
- GIB in COVID-19 patients is associated with low mortality and a manageable risk of rebleeding.
- Endoscopic and IR interventions should be prioritized for hemodynamically unstable patients or those refractory to conservative measures.
Background/Aims:
More than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB).
Methods:
A systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB.
Results:
Our search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%-9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%-18.4%).
Conclusion:
The majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful.
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