Upper gastrointestinal bleeding in coronavirus disease 2019 patients

Abstract

Purpose of reviewUpper gastrointestinal bleeding (UGIB) has significant morbidity and UGIB cases have been described in coronavirus disease 2019 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 findingsUGIB 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.

Predicting mortality in patients with nonvariceal upper gastrointestinal bleeding using machine-learning

“…Ensuring a risk stratification at patient admission might be helpful in choosing the proper time for endoscopy, especially in small regional hospitals which do not provide a full-time endoscopy service. Moreover, probably a turning point in medicine in the last years, the COVID-19 pandemic almost changed patients' presentation in the emergency room, as well as patients' admission (16). A general decrease in patients' admission has been observed in the first months of the pandemic for all types of disease, and also for UGIB patients.…”