Incidence and Outcomes of Upper GI Bleeding in Hospitalized SARS-CoV-2 Patients

TL;DR

This study examines the higher incidence and worse outcomes of upper GI bleeding in hospitalized patients with SARS-CoV-2 compared to those without the virus.

Contribution

The study identifies unique clinical features and higher mortality in SARS-CoV-2–positive patients with upper GI bleeding.

Findings

Duodenal ulcer was the most common cause of GI bleeding in SARS-CoV-2–positive patients.

SARS-CoV-2–positive patients required more transfusions, medications, and had higher in-hospital mortality.

Nearly 25% of patients underwent endoscopy more than 48 hours after bleeding onset.

Abstract

Background: In March 2020, the severe acute respiratory distress syndrome coronavirus 2 (COVID-19) became a worldwide pandemic. Recently, it has been shown that direct entry of this virus in the gastrointestinal (GI) epithelial cells causes tissue damage and the use of anticoagulants increases the risk of GI bleeding. These pose real concerns for the gastroenterologists concerning the mortality, overall incidence, and management of upper GI bleeding in SARS-CoV-2–positive patients.

Methods: This retrospective study includes patients 18 years or older admitted to our health system with an upper GI bleed (UGB). Patients with possible UGB, endoscopy, and SARS-CoV-2–positive testing (n = 587) formed the initial cohort. In-depth data were collected for symptoms, medications, source of bleeding, and interventions for subsets of test and control subjects.

Results: Duodenal ulcer was the most common etiology for GI bleeding in SARS-CoV-2–positive patients, while esophagitis was the most common etiology in control subjects. SARS-CoV-2–positive patients had significant progressive anemia and had to be given more blood transfusions, steroids, proton pump inhibitors, and immunosuppressants. In-hospital mortality was greater in the experimental group (12.8%) than in the control group (5.1%). Furthermore, the SARS-CoV-2–positive patients had more therapeutic interventions compared to the SARS-CoV-2–negative patients. Nearly one-quarter of all patients had an endoscopy over 48 h after bleeding was observed.

Conclusions: Healthcare providers should be aware of the greater therapeutic needs of SARS-CoV-2–positive patients with UGB. Our data helps shed light on the relationship between SARS-CoV-2 and GI bleeding due to SARS-CoV-2–related tissue damage and treatment affecting the GI tract.

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