Upper gastrointestinal bleeding in COVID-19 inpatients: Incidence and management in a multicenter experience from Northern Italy

Mauro, Aurelio; Grazia, F. De; Lenti, Marco Vincenzo; Penagini, Roberto; Frego, Roberto; Ardizzone, Sandro; Savarino, Edoardo; Radaelli, Franco; Bosani, M.; Orlando, Stefania; Amato, Arnaldo; Dinelli, M.; Ferretti, Francesca; Filippi, Elisabetta; Vecchi, Maurizio; Stradella, Davide; Bardone, M.; Pozzi, L.; Rovedatti, L.; Strada, E.

doi:10.1016/j.clinre.2020.07.025

Cited by 72 publications

(117 citation statements)

References 28 publications

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“…Certainly, the small sample size might have also influenced the result. In Northern Italy, the most common cause of UGIB was peptic ulcer disease [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Acute Upper Gastrointestinal Bleeding in Xingtai City

Duan

Liu

et al. 2021

Gastroenterology Research and Practice

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Background and Aims. The coronavirus disease 2019 (COVID-19) has severely impacted the daily practice of gastrointestinal endoscopy worldwide. Most endoscopy centers in China were shut down in late January 2020. We investigated the impact of the shutdown on acute upper gastrointestinal bleeding (AUGIB) events in Xingtai City, Hebei Province, China. Methods. A web-based survey collected information on gastroscopy workload and AUGIB events. The study period was from 4 weeks before to 4 weeks after lockdown initiation in Xingtai City. Fourteen public gastrointestinal endoscopy centers performing emergency endoscopies were contacted via e-mail to collect weekly emergency gastroscopy volumes and the number of AUGIB events. AUGIB was defined as recent melena, hematemesis, or both, with an endoscopically visible source of bleeding. Results. Twelve (85.7%) of the 14 surveyed gastrointestinal endoscopy centers in the city- and county-level hospitals responded. Altogether, 4,045 and 1,077 gastroscopy procedures were performed 4 weeks before and after lockdown initiation (73.4% reduction), respectively. Peptic ulcer-related AUGIB and variceal AUGIB events showed a 58.5% and 52.9% decline, respectively, compared with pre-COVID-19 data. Although the absolute number of AUGIB events decreased during the pandemic (from 149 to 66), the likelihood of detecting AUGIB during gastroscopy increased (3.68% (pre-COVID-19 period) versus 6.13% (COVID-19 period); P < 0.05 ). Conclusion. The COVID-19 pandemic resulted in a considerable reduction in gastroscopy workload and AUGIB events; however, the likelihood of detecting AUGIB increased significantly during gastroscopies.

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“…Certainly, the small sample size might have also influenced the result. In Northern Italy, the most common cause of UGIB was peptic ulcer disease [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Acute Upper Gastrointestinal Bleeding in Xingtai City

Duan

Liu

et al. 2021

Gastroenterology Research and Practice

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“…Mauro et al. 46 described 11 patients who had active peptic ulcers, erosive gastritis and bleeding from gastro-oesophageal varices. A summary of the reported investigation findings and treatments used are provided in Table 3 .…”

Section: Management Of Covid-19-related Gi Manifestationsmentioning

confidence: 99%

Gastrointestinal manifestations in COVID-19

Kariyawasam

Jayarajah

Riza

et al. 2021

Transactions of the Royal Society of Tropical Medicine and Hygiene

113

105

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Coronavirus disease 2019 (COVID-19), a respiratory viral infection, has affected more than 78 million individuals worldwide as of the end of December 2020. Previous studies reported that severe acute respiratory syndrome coronavirus 1 and Middle East respiratory syndrome–related coronavirus infections may affect the gastrointestinal (GI) system. In this review we outline the important GI manifestations of COVID-19 and discuss the possible underlying pathophysiological mechanisms and their diagnosis and management. GI manifestations are reported in 11.4–61.1% of individuals with COVID-19, with variable onset and severity. The majority of COVID-19-associated GI symptoms are mild and self-limiting and include anorexia, diarrhoea, nausea, vomiting and abdominal pain/discomfort. A minority of patients present with an acute abdomen with aetiologies such as acute pancreatitis, acute appendicitis, intestinal obstruction, bowel ischaemia, haemoperitoneum or abdominal compartment syndrome. Severe acute respiratory syndrome coronavirus 2 RNA has been found in biopsies from all parts of the alimentary canal. Involvement of the GI tract may be due to direct viral injury and/or an inflammatory immune response and may lead to malabsorption, an imbalance in intestinal secretions and gut mucosal integrity and activation of the enteric nervous system. Supportive and symptomatic care is the mainstay of therapy. However, a minority may require surgical or endoscopic treatment for acute abdomen and GI bleeding.

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“…Despite the presence of fibrinolysis shutdown in a significant proportion of patients with COVID-19, bleeding complications, including hemorrhagic stroke 56 and gastrointestinal bleeding, 57 are not uncommon and deserve special consideration. A systematic review and meta-analysis of hospitalized patients with COVID-19 reported a 7.8% overall pooled incidence of bleeding with 3.9% comprising major bleeding complications.…”

Section: Thrombotic and Bleeding Complica-tions In Covid-19-associated Fibrino-lysis Shutdownmentioning

confidence: 99%

Fibrinolysis Shutdown in COVID-19: Clinical Manifestations, Molecular Mechanisms, and Therapeutic Implications

Meizoso

Moore

2021

Journal of the American College of Surgeons

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The COVID-19 pandemic has introduced a global public health threat unparalleled in our history. The most severe cases are marked by ARDS attributed to microvascular thrombosis. Hypercoagulability, resulting in a profoundly prothrombotic state, is a distinct feature of COVID-19 and is accentuated by a high incidence of fibrinolysis shutdown. The aims of this review were to describe the manifestations of fibrinolysis shutdown in COVID-19 and its associated outcomes, review the molecular mechanisms of dysregulated fibrinolysis associated with COVID-19, and discuss potential implications and therapeutic targets for patients with severe COVID-19.

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Upper gastrointestinal bleeding in COVID-19 inpatients: Incidence and management in a multicenter experience from Northern Italy

Cited by 72 publications

References 28 publications

Impact of the COVID-19 Pandemic on Acute Upper Gastrointestinal Bleeding in Xingtai City

Impact of the COVID-19 Pandemic on Acute Upper Gastrointestinal Bleeding in Xingtai City

Gastrointestinal manifestations in COVID-19

Fibrinolysis Shutdown in COVID-19: Clinical Manifestations, Molecular Mechanisms, and Therapeutic Implications

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