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

Hassan Ashktorab¹, Tiziano Russo¹, Gholamreza Oskrochi²

¹Department of Medicine, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, District of Columbia.

Gastro Hep Advances

|March 15, 2022

Insights

Gastrointestinal bleeding (GIB) in coronavirus disease-2019 (COVID-19) patients occurs at a low incidence but is associated with a significantly higher mortality rate. Melena is the most common presentation, with ulcers being frequent endoscopic findings.

Area of Science:

Gastroenterology
Infectious Diseases
Internal Medicine

Background:

Coronavirus disease-2019 (COVID-19) has caused a global pandemic with over 404 million infections.
Gastrointestinal bleeding (GIB) is a potential complication in COVID-19 patients, necessitating investigation into its incidence and impact.

Purpose of the Study:

To analyze data on gastrointestinal bleeding (GIB) and endoscopic findings in COVID-19 patients in Western countries.
To compare outcomes and comorbidities between COVID-19 patients with and without GIB.

Main Methods:

Systematic review of studies on confirmed COVID-19 cases with GIB in Western countries.
Data collected from PubMed and Google Scholar databases between June 20, 2020, and July 10, 2021.
Comparison of outcomes and comorbidities with a large cohort of non-GIB COVID-19 patients.

Main Results:

12 studies involving 808 COVID-19 patients with GIB were analyzed. The overall incidence of GIB was 0.06%.
COVID-19 patients with GIB had a significantly higher mortality rate (25.4% vs 16.4%) compared to those without GIB.
Melena was the most common presentation (47.5%), and ulcers were common endoscopic findings. Hypertension was strongly associated with death.

Conclusions:

The incidence of GIB in COVID-19 patients is comparable to the general population.
COVID-19 patients with GIB experience worse outcomes, including a higher risk of mortality.
Hypertension, hematochezia, and esophagogastroduodenoscopy were significantly associated with mortality in COVID-19 patients with GIB.

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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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