A “double-hit” damage mechanism can explain self-limited GI bleeding in COVID-19 pneumonia

Dioscoridi, Lorenzo; Giannetti, Aurora; Massad, Mutaz; Forti, Edoardo; Pugliese, Francesco; Cintolo, Marcello; Bonato, Giulia; Rosa, Roberto; Mutignani, Massimiliano

doi:10.1016/j.gie.2020.12.022

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…In patients where the association might be judged as causative, the virus might lead to GIB through direct mucosal damage followed by a strong immune response and indirect consequences of viral-induced hypoxia and coagulopathy. 8 Indeed, SARS-CoV-2 can bind to the angiotensinconverting enzyme 2 (ACE2) receptors present on cells as the main route of access. 34 These receptors are abundant on the epithelial cells lining not only the lungs, but also the GI tract.…”

Section: Discussionmentioning

confidence: 99%

“…6 In particular, the virus is thought to cause both direct and indirect damage, via a "double-hit" mechanism. 8 Direct damage refers to the GI mucosal injury with consequent immune response and inflammation, and indirect damage is the subsequent hypoxic stress that stems from coagulopathy. 9 Little is known about the underlying conditions that increase the risk of developing GIB.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Endoscopic Outcomes in COVID-19 Patients With Gastrointestinal Bleeding

Ashktorab

Russo

Oskrochi

et al. 2022

Gastro Hep Advances

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and Endoscopic Outcomes in COVID-19 Patients With Gastrointestinal Bleeding

Ashktorab

Russo

Oskrochi

et al. 2022

Gastro Hep Advances

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“…Stress ulcers may be another major cause of bleeding unrelated to SARS-COV-2[ 41 ]. Furthermore, assisted ventilation techniques could cause stress ulceration and generate GIB[ 42 ]. However, rates of thrombosis and bleeding related to COVID-19 were congruent to those reported in hospitalized patients with comparable grades of critical illness.…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 in individuals with and without pre-existent digestive disorders with a particular focus on elderly patients

Papa¹,

Covino²,

Lucia³

et al. 2023

World J Gastroenterol

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Coronavirus disease 2019 (COVID-19) has several extrapulmonary symptoms. Gastrointestinal (GI) symptoms are among the most frequent clinical manifestations of COVID-19, with severe consequences reported in elderly patients. Furthermore, the impact of COVID-19 on patients with pre-existing digestive diseases still needs to be fully elucidated, particularly in the older population. This review aimed to investigate the impact of COVID-19 on the GI tract, liver, and pancreas in individuals with and without previous digestive diseases, with a particular focus on the elderly, highlighting the distinctive characteristics observed in this population. Finally, the effectiveness and adverse events of the anti-COVID-19 vaccination in patients with digestive disorders and the peculiarities found in the elderly are discussed.

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“…This pathophysiological mechanism of GIB in patients with COVID-19 is explained by the entrance of SARS-CoV-2 into intestinal host cells through ACE-2 receptors that are highly expressed in gastrointestinal organs [ 10 , 11 ]. This entrance causes a local gastrointestinal infection that can lead to bleeding [ 17 , 18 ]. Bleeding can also be favored by medication against the COVID-19 infection, which usually consists of corticosteroids and anticoagulants (to treat the hypercoagulability that COVID-19 infection can cause) [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

Karlafti,

Tsavdaris,

Kotzakioulafi

et al. 2023

Medicina

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Introduction: Severe acute respiratory syndrome coronavirus 2 caused the coronavirus disease of 2019 (COVID-19), which rapidly became a pandemic, claiming millions of lives. Apart from the main manifestations of this infection concerning the respiratory tract, such as pneumonia, there are also many manifestations from the gastrointestinal tract. Of these, bleeding from the gastrointestinal tract is a significant complication quite dangerous for life. This bleeding is divided into upper and lower, and the primary pathophysiological mechanism is the entering of the virus into the host cells through the Angiotensin-converting enzyme 2 receptors. Also, other comorbidities and the medication of corticosteroids and anticoagulants are considered to favor the occurrence of gastrointestinal bleeding (GIB). Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the studies were searched in two different databases (Scopus and PubMed) from November 2019 until February 2023. All studies that reported GIB events among COVID-19 patients were included. Results: 33 studies were selected and reviewed to estimate the prevalence of GIB. A total of 134,905 patients with COVID-19 were included in these studies, and there were 1458 episodes of GIB. The prevalence of GIB, in these 33 studies, ranges from 0.47% to 19%. This range of prevalence is justified by the characteristics of the COVID-19 patients. These characteristics are the severity of COVID-19, anticoagulant and other drug treatments, the selection of only patients with gastrointestinal manifestations, etc. The pooled prevalence of gastrointestinal bleeding was estimated to be 3.05%, rising to 6.2% when only anticoagulant patients were included. Conclusions: GIB in COVID-19 patients is not a rare finding, and its appropriate and immediate treatment is necessary as it can be life-threatening. The most common clinical findings are melena and hematemesis, which characterize upper GIB. Treatment can be conservative; however, endoscopic management of bleeding with embolization is deemed necessary in some cases.

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A “double-hit” damage mechanism can explain self-limited GI bleeding in COVID-19 pneumonia

Cited by 5 publications

References 7 publications

Clinical and Endoscopic Outcomes in COVID-19 Patients With Gastrointestinal Bleeding

Clinical and Endoscopic Outcomes in COVID-19 Patients With Gastrointestinal Bleeding

Impact of COVID-19 in individuals with and without pre-existent digestive disorders with a particular focus on elderly patients

The Prevalence of Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

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