tetano
Editor, Senior Moderator
Gastro Hep Adv
. 2022 Mar 10.
doi: 10.1016/j.gastha.2022.02.021. Online ahead of print.
Clinical and Endoscopic Outcomes in COVID-19 Patients with Gastrointestinal Bleeding
Hassan Ashktorab[SUP] 1 [/SUP], Tiziano Russo[SUP] 1 [/SUP], Gholamreza Oskrochi[SUP] 2 [/SUP], Giovanni Latella[SUP] 3 [/SUP], Sara Massironi[SUP] 4 [/SUP], Martina Luca[SUP] 4 [/SUP], Lakshmi G Chirumamilla[SUP] 1 [/SUP], Adeyinka O Laiyemo[SUP] 1 [/SUP], Hassan Brim[SUP] 1 [/SUP]
Affiliations
Abstract
Background & aims: Over 404 million people worldwide have been infected with COVID-19, 145 million in the United States (77 million) and Europe (151 million) alone (as of Feb. 10[SUP]th[/SUP], 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[SUP]th[/SUP], 2020, to July 10[SUP]th[/SUP], 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 non-GIB cohort, death rate was significantly high in COVID-19 patients with GIB (16.4% vs. 25.4%, p<0.001, respectively). Endoscopic treatment was rarely necessary, and blood transfusion was the most common GIB treatment. 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 endoscopies (36.4%), respectively. The GIB cohort had worse outcomes and higher incidence of hypertension (61.1%), liver disease (11.2%), and cancer (13.6%) when compared with non-GIB cohort. Death was strongly associated with hypertension (p<0.001, r=0.814), hematochezia (p<0.001, r=0.646) and EGD (p<0.001, r=0.591) in COVID-19 patients with GIB.
Conclusion: 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: Coronavirus disease-19; Endoscopy; Gastrointestinal bleeding; Hematemesis; Melena.
. 2022 Mar 10.
doi: 10.1016/j.gastha.2022.02.021. Online ahead of print.
Clinical and Endoscopic Outcomes in COVID-19 Patients with Gastrointestinal Bleeding
Hassan Ashktorab[SUP] 1 [/SUP], Tiziano Russo[SUP] 1 [/SUP], Gholamreza Oskrochi[SUP] 2 [/SUP], Giovanni Latella[SUP] 3 [/SUP], Sara Massironi[SUP] 4 [/SUP], Martina Luca[SUP] 4 [/SUP], Lakshmi G Chirumamilla[SUP] 1 [/SUP], Adeyinka O Laiyemo[SUP] 1 [/SUP], Hassan Brim[SUP] 1 [/SUP]
Affiliations
- PMID: 35287301
- PMCID: PMC8907011
- DOI: 10.1016/j.gastha.2022.02.021
Abstract
Background & aims: Over 404 million people worldwide have been infected with COVID-19, 145 million in the United States (77 million) and Europe (151 million) alone (as of Feb. 10[SUP]th[/SUP], 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[SUP]th[/SUP], 2020, to July 10[SUP]th[/SUP], 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 non-GIB cohort, death rate was significantly high in COVID-19 patients with GIB (16.4% vs. 25.4%, p<0.001, respectively). Endoscopic treatment was rarely necessary, and blood transfusion was the most common GIB treatment. 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 endoscopies (36.4%), respectively. The GIB cohort had worse outcomes and higher incidence of hypertension (61.1%), liver disease (11.2%), and cancer (13.6%) when compared with non-GIB cohort. Death was strongly associated with hypertension (p<0.001, r=0.814), hematochezia (p<0.001, r=0.646) and EGD (p<0.001, r=0.591) in COVID-19 patients with GIB.
Conclusion: 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: Coronavirus disease-19; Endoscopy; Gastrointestinal bleeding; Hematemesis; Melena.