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COVID-19 and Upper Gastrointestinal Bleeding; Etiology, Risk Factors, and Outcomes: A Case-Control Study

Sara Shafieipour1, Mohammad Rezaei Zadeh Rukerd2, Niloofar Farsiu1

  • 1Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.

Middle East Journal of Digestive Diseases
|May 5, 2025
PubMed

Insights

COVID-19 patients with upper gastrointestinal bleeding (UGIB) face longer intensive care unit (ICU) stays and higher mortality. History of cirrhosis and previous gastrointestinal bleeding (GIB) are significant risk factors for UGIB in these patients.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Gastrointestinal (GI) symptoms are common in COVID-19, but upper gastrointestinal bleeding (UGIB) is a critical complication.
  • Understanding the specific risks and outcomes of UGIB in COVID-19 patients is crucial for clinical management.

Purpose of the Study:

  • To investigate the etiology, risk factors, esophagogastroduodenoscopy (EGD) findings, and outcomes of UGIB in hospitalized COVID-19 patients.
  • To identify predictors of UGIB in the context of COVID-19 infection.

Main Methods:

  • Retrospective case-control study involving 127 COVID-19 patients.
  • Patients were diagnosed via reverse transcription polymerase chain reaction (RT-PCR).
  • Comparison of 64 patients with UGIB (cases) and 63 without (controls).

Main Results:

  • Melena (37.5%) and peptic ulcer (21.87%) were the most frequent UGIB symptom and EGD finding, respectively.
  • COVID-19 patients with UGIB had significantly longer ICU stays (11.58 vs. 8.29 days, P=0.03).
  • History of GIB (17.2%) and liver cirrhosis (12.5%) were significant risk factors for UGIB (P=0.001 and P=0.01, respectively).

Conclusions:

  • COVID-19 patients with UGIB experience more intensive care unit (ICU) stays.
  • Melena and peptic ulcers are common presentations and findings in COVID-19 patients with UGIB.
  • Liver cirrhosis and prior GIB history increase the risk of UGIB in COVID-19 patients.
Abstract

Keywords:
COVID-19Gastrointestinal bleedingIranOutcomeRisk factor

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