Upper gastrointestinal bleeding in coronavirus disease 2019 patients
Aurelio Mauro1,2, Federico De Grazia2, Andrea Anderloni2
1First Department of Internal Medicine.
Insights
Upper gastrointestinal bleeding (UGIB) in COVID-19 patients occurs at a similar rate to the general population. Anticoagulants do not increase UGIB risk, and conservative management is often effective.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Critical Care Medicine
Background:
- Upper gastrointestinal bleeding (UGIB) is a significant concern with considerable morbidity.
- COVID-19 patients have been reported to experience UGIB, posing management challenges due to severe pneumonia and infection transmission risks.
Purpose of the Study:
- To review recent literature on the incidence, clinical and endoscopic features, and optimal management of UGIB in patients with COVID-19.
Main Methods:
- Literature review of recent studies on UGIB in COVID-19 patients.
Main Results:
- UGIB incidence in COVID-19 patients ranges from 0.5% to 1.9%, with melena or hematemesis as common presentations.
- Peptic ulcers are the most frequent endoscopic finding. High Charlson Comorbidity Index, dialysis, acute kidney injury, and advanced cancer increase UGIB risk.
- Anticoagulant use in COVID-19 patients was not linked to a higher UGIB incidence. Conservative management showed outcomes comparable to endoscopic treatment.
Conclusions:
- The incidence of UGIB in COVID-19 patients mirrors that of the general population.
- Anticoagulants commonly used in COVID-19 care do not elevate UGIB risk.
- Conservative management is a viable and effective strategy, particularly for patients at risk of intubation.
Purpose Of Review:
Upper gastrointestinal bleeding (UGIB) has significant morbidity and UGIB cases have been described in coronavirus disease 2019 (COVID-19) patients. Management of this condition can be challenging considering both the possible severe COVID-19-related pneumonia as well as the risk of the virus spreading from patients to health operators. The aim of this paper is to review the most recent studies available in the literature in order to evaluate the actual incidence of UGIB, its clinical and endoscopic manifestations and its optimal management.
Recent Findings:
UGIB has an incidence between 0.5% and 1.9% among COVID-19 patients, and it typically presents with melena or hematemesis. Peptic ulcers are the most common endoscopic findings. High Charlson Comorbidity Index (CCI), dialysis, acute kidney injury and advanced oncological disease increase the risk for UGIB. Although anticoagulants are commonly used in COVID-19 patients they are not associated with an increased incidence of UGIB. Conservative management is a common approach that results in similar outcomes compared to upper GI endoscopic treatment. Apparently, UGIB in COVID-19 seems not have a detrimental effect and only one study showed an increased mortality in those who developed UGIB during hospitalization.
Summary:
Incidence of UGIB in COVID-19 patients is similar to that of the general population. Despite the widespread use of anticoagulants in these patients, they are not associated with an increased risk of UGIB. Conservative management could be an effective option, especially for patients that are at risk of intubation.
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