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Upper gastrointestinal bleeding in COVID-19 inpatients: Incidence and management in a multicenter experience from Northern Italy - 02/09/20

Doi : 10.1016/j.clinre.2020.07.025 
Aurelio Mauro a, , Federico De Grazia a, Marco Vincenzo Lenti b, Roberto Penagini c, d, Roberto Frego e, Sandro Ardizzone f, Edoardo Savarino g, Franco Radaelli h, Matteo Bosani i, Stefania Orlando j, Arnaldo Amato h, Marco Dinelli e, Francesca Ferretti f, Elisabetta Filippi c, d, Maurizio Vecchi c, d, Davide Stradella j, Marco Bardone a, Lodovica Pozzi a, Laura Rovedatti a, Elena Strada a, Antonio Di Sabatino b
a Endoscopy Unit, First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy 
b First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy 
c Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy 
d Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy 
e Endoscopy Unit, San Gerardo Hospital, Monza, Italy 
f Gastrointestinal Unit, ASST-Fatebenefratelli Sacco, L. Sacco Department of Biochemical and Clinical Sciences, University of Milan, Italy 
g Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy 
h Gastroenterology Department, Valduce Hospital, Como, Italy 
i Gastroenterology Unit, General Hospital Legnano, Legnano, Italy 
j Department of Gastroenterology, “Maggiore Della Carit” Hospital, Novara, Italy 

Corresponding author.

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Highlights

UGIB has a prevalence of 0.47% in non-ICU COVID-19 patients and peptic disease is the most common finding.
Half of patients were managed conservatively or with delayed endoscopy.
This is the first report that evaluates incidence of UGIB in COVID-19 patients.
Conservative management and delayed endoscopy could be a successful option in patients with significant respiratory impairment.

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Abstract

Background

COVID-19 patients have an increased susceptibility to develop thrombotic complications, thus thromboprophylaxis is warranted which may increase risk of upper gastrointestinal bleeding (UGIB). Our aim was to evaluate incidence of UGIB and use of upper GI endoscopy in COVID-19 inpatients.

Methods

The medical and endoscopic management of UGIB in non-ICU COVID-19 patients has been retrospectively evaluated. Glasgow Blatchford score was calculated at onset of signs of GI bleeding. Timing between onset of signs of GI bleeding and execution, if performed, of upper GI endoscopy was evaluated. Endoscopic characteristics and outcome of patients were evaluated overall or according to the execution or not of an upper GI endoscopy before and after 24h.

Results

Out of 4871 COVID-19 positive patients, 23 presented signs of UGIB and were included in the study (incidence 0.47%). The majority (78%) were on anticoagulant therapy or thromboprophylaxis. In 11 patients (48%) upper GI endoscopy was performed within 24h, whereas it was not performed in 5. Peptic ulcer was the most common finding (8/18). Mortality rate was 21.7% for worsening of COVID-19 infection. Mortality and rebleeding were not different between patients having upper GI endoscopy before or after 24h/not performed. Glasgow Blatchford score was similar between the two groups (13;12–16 vs 12;9–15).

Conclusion

Upper GI bleeding complicated hospital stay in almost 0.5% of COVID-19 patients and peptic ulcer disease is the most common finding. Conservative management could be an option in patients that are at high risk of respiratory complications.

Le texte complet de cet article est disponible en PDF.

Abbreviations : COVID 19, GBS, ICU, LMWH, UGIB

Keywords : Upper gastrointestinal bleeding, COVID-19, Peptic ulcer


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