Gastrointestinal Bleeding in COVID-19-Infected Patients

Cappell, By Mitchell S.; Friedel, David

doi:10.1016/j.gtc.2022.10.004

Cited by 10 publications

(9 citation statements)

References 97 publications

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“…The source and extent of bleeding must be determined after the patient has been stabilised through diagnostic testing. Upper endoscopy may be used for this, allowing for direct visualisation of the digestive system and potential interventions like thermal coagulation, sclerosing agent injection, or the insertion of haemostatic clips 40 . The risk of aerosol generation during endoscopy in COVID‐19 patients must be carefully considered, and the right precautions should be taken to reduce exposure to medical professionals 40 …”

Section: Discussionmentioning

confidence: 99%

Prevalence and outcomes of upper gastrointestinal bleeding in COVID‐19: A systematic review and meta‐analysis

Rathore,

Wint,

Goyal

et al. 2024

Reviews in Medical Virology

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Upper gastrointestinal bleeding (UGIB) in COVID‐19 presents challenges in patient management. Existing studies lack comprehensive review due to varied designs, samples, and demographics. A meta‐analysis can provide valuable insights into the incidence, features, and outcomes of UGIB in COVID‐19. A comprehensive literature search was carried out using several databases. We considered all appropriate observational studies from all over the world. Mantel‐Haenszel odds ratios and associated 95% confidence intervals (CIs) were produced to report the overall effect size using random effect models. Besides, Random effects models were used to calculate the overall pooled prevalence. Funnel plots, Egger regression tests, and Begg‐Mazumdar's rank correlation test were used to appraise publication bias. Data from 21 articles consisting of 26,933 COVID‐19 patients were considered. The pooled estimate of UGIB prevalence in patients admitted with COVID‐19 across studies was 2.10% (95% CI, 1.23–3.13). Similarly, the overall pooled estimate for severity, mortality, and rebleeding in COVID‐19 patients with UGIB was 55% (95% CI, 37.01–72.68), 29% (95% CI, 19.26–40.20) and 12.7% (95% CI, 7.88–18.42) respectively. Further, UGIB in COVID‐19 patients was associated with increased odds of severity (OR = 3.52, 95% CI 1.80–6.88, P = 0.001) and mortality (OR = 2.16, 95% CI 1.33–3.51, P = 0.002) compared with patients without UGIB. No significant publication bias was evident in the meta‐analysis. The results of our study indicate that UGIB in individuals with COVID‐19 is linked to negative outcomes such as severe illness, higher mortality rates, and an increased risk of re‐bleeding. These findings highlight the significance of identifying UGIB as a significant complication in COVID‐19 cases and emphasise the importance of timely clinical assessment and proper treatment.

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Section: Discussionmentioning

confidence: 99%

Prevalence and outcomes of upper gastrointestinal bleeding in COVID‐19: A systematic review and meta‐analysis

Rathore,

Wint,

Goyal

et al. 2024

Reviews in Medical Virology

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“… 9 Interestingly, GI biopsies of COVID-19-infected patients with GI bleeding detected the SARS CoV2 RNA in gastric, duodenal, and rectal tissues. 3 In addition, the risk of thromboembolic events and coagulopathy associated with COVID-19 has been well recognized, and recent guidelines support the use of anticoagulation therapy in critically ill COVID-19 infected patients. 10 Ischemic colitis in COVID-19 patients is associated with hypercoagulation.…”

Section: Discussionmentioning

confidence: 99%

“…The three predominant reported characteristics of GI bleeding are a) that it is often from mucosal inflammation and erosions leading to mild bleeding, b) severe GI bleeding from peptic ulcer disease or severe gastritis from COVID-19 pneumonia, and c) lower GI bleeding resulting from ischemic colitis associated with thrombosis and hyper coagulopathy from COVID-19 infection. 3 Despite the anticipated risk of contracting COVID-19 from GI endoscopy performed on COVID-19-infected patients, the actual risks reported do not indicate it to be high. 3 The widespread use of sanitization techniques, personal protective equipment, and the advent of vaccinations against the virus have gradually enhanced the safety and frequency of performing GI endoscopy in COVID-19-infected patients.…”

Section: Introductionmentioning

confidence: 98%

“… 3 Despite the anticipated risk of contracting COVID-19 from GI endoscopy performed on COVID-19-infected patients, the actual risks reported do not indicate it to be high. 3 The widespread use of sanitization techniques, personal protective equipment, and the advent of vaccinations against the virus have gradually enhanced the safety and frequency of performing GI endoscopy in COVID-19-infected patients. GI bleeding in COVID-19 patients presented as a major healthcare system challenge due to the rise in the number of cases and the introduction of newer viral variants.…”

Section: Introductionmentioning

confidence: 98%

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Gastrointestinal Bleeding in COVID-19 Infected Patients, and Management Outcomes

Al Hanaei,

AlKindi,

Alkhemeiri

et al. 2024

IJGM

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Introduction Gastrointestinal bleeding in COVID-19-infection poses unique challenges to patients owing to the high risk of concomitant respiratory failure. However, endoscopic care providers are prone to transmission. This study aimed to understand the risk and management outcomes of gastrointestinal bleeding in COVID-19-infected patients. Methods Data were abstracted from electronic patient medical records, using ICD 10 codes, and demographic and clinical data were collected, for COVID-19-infected patients who developed gastrointestinal (GI) bleeding. Complications related to COVID-19 infection and management outcomes of GI bleeding were studied. Statistically, descriptive analysis was used because of the small sample size. Results Eighteen COVID-19-infected patients developed episodes of GI bleeding, yielding a prevalence of 0.45%. Their mean age was 74.8 years, 55.5% were female, and 66.6% of patients (n=12) had upper GI bleeding symptoms, predominantly melena (55.5%), followed by coffee ground nasogastric aspirates (n=2). Only two patients (11.11%) had episodes of lower GI bleeding, and the remaining four patients (22.2%) had recurrent acute anemia requiring blood transfusion. The Glasgow-Blatchford score (GBS) at presentation ranged between 6 to 16 (mean 8.8) and seven patients (38.8%) underwent endoscopic evaluation for GI bleeding. The predominant comorbid conditions included hypertension (22.2%), diabetes mellitus (27.7%), chronic kidney disease (50%), ischemic heart disease (33%), atrial fibrillation (11.1%), and peripheral vascular disease (11.1%). The median hospitalization was 24.6 days (range: 3–54 days). The 30-day mortality rate in our cohort was 22.2%, (4/18) mainly noted in older patients aged> 60 years with comorbid conditions and severe COVID-19 infection. Conclusion The prevalence of GI bleeding observed in our cohort was approximately 0.45%, significantly lower than the global prevalence observed, majority (66%) had upper GI bleeding. The exact reasons for the observed low prevalence of GI bleeding cannot be explained and will be the subject of future research.

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“…In addition to respiratory complications, up to 30% of COVID-19 patients experience gastrointestinal symptoms, including diarrhea, abdominal discomfort, loss of appetite and vomiting (Al-Momani et al, n.d.; Hayashi et al, 2021; Zhong et al, 2020). Some COVID-19 patients even develop severe duodenitis associated with gastrointestinal bleeding requiring red blood cell transfusion (Cappell and Friedel, 2023; Eleftheriotis et al, 2023). Impaired intestinal barrier function in SARS-CoV-2 infection allows microbial and endotoxin translocation, which triggers inflammation and may lead to sepsis or contribute to chronic inflammation (Assimakopoulos et al, 2022; Eleftheriotis et al, 2023; Yamada et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Attenuated replication and damaging effects of SARS-CoV-2 Omicron variants in an intestinal epithelial barrier model

Volcic,

Nchioua,

Pastorio

et al. 2024

Preprint

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Many COVID-19 patients suffer from gastrointestinal symptoms and impaired intestinal barrier function may play a key role in Long COVID. Despite its importance, the impact of SARS-CoV-2 on intestinal epithelia is poorly understood. To address this, we established an intestinal barrier model integrating epithelial Caco-2 cells, mucus-secreting HT29 cells and human Raji cells. This gut epithelial model allows efficient differentiation of Caco-2 cells into microfold-like cells, faithfully mimics intestinal barrier function, and is highly permissive to SARS-CoV-2 infection. Early strains of SARS-CoV-2 and the Delta variant replicated with high efficiency, severely disrupted barrier function, and depleted tight junction proteins, such as claudin-1, occludin and ZO-1. In comparison, Omicron subvariants also depleted ZO-1 from tight junctions but had fewer damaging effects on mucosal integrity and barrier function. Remdesivir and the TMPRSS2 inhibitor Camostat prevented SARS-CoV-2 replication and thus epithelial barrier damage, while the Cathepsin inhibitor E64d was ineffective. Our results support that SARS-CoV-2 disrupts intestinal barrier function but further suggest that circulating Omicron variants are less damaging than earlier viral strains.

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Gastrointestinal Bleeding in COVID-19-Infected Patients

Cited by 10 publications

References 97 publications

Prevalence and outcomes of upper gastrointestinal bleeding in COVID‐19: A systematic review and meta‐analysis

Prevalence and outcomes of upper gastrointestinal bleeding in COVID‐19: A systematic review and meta‐analysis

Gastrointestinal Bleeding in COVID-19 Infected Patients, and Management Outcomes

Attenuated replication and damaging effects of SARS-CoV-2 Omicron variants in an intestinal epithelial barrier model

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