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

Autor: Mauro A; Endoscopy Unit, First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy. Electronic address: a.mauro@smatteo.pv.it., De Grazia F; Endoscopy Unit, First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy., Lenti MV; First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy., Penagini R; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy., Frego R; Endoscopy Unit, San Gerardo Hospital, Monza, Italy., Ardizzone S; Gastrointestinal Unit, ASST-Fatebenefratelli Sacco, L. Sacco Department of Biochemical and Clinical Sciences, University of Milan, Italy., Savarino E; Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy., Radaelli F; Gastroenterology Department, Valduce Hospital, Como, Italy., Bosani M; Gastroenterology Unit, General Hospital Legnano, Legnano, Italy., Orlando S; Department of Gastroenterology, 'Maggiore Della Carit' Hospital, Novara, Italy., Amato A; Gastroenterology Department, Valduce Hospital, Como, Italy., Dinelli M; Endoscopy Unit, San Gerardo Hospital, Monza, Italy., Ferretti F; Gastrointestinal Unit, ASST-Fatebenefratelli Sacco, L. Sacco Department of Biochemical and Clinical Sciences, University of Milan, Italy., Filippi E; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy., Vecchi M; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy., Stradella D; Department of Gastroenterology, 'Maggiore Della Carit' Hospital, Novara, Italy., Bardone M; Endoscopy Unit, First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy., Pozzi L; Endoscopy Unit, First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy., Rovedatti L; Endoscopy Unit, First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy., Strada E; Endoscopy Unit, First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy., Di Sabatino A; First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Jazyk: angličtina
Zdroj: Clinics and research in hepatology and gastroenterology [Clin Res Hepatol Gastroenterol] 2021 May; Vol. 45 (3), pp. 101521. Date of Electronic Publication: 2020 Aug 14.
DOI: 10.1016/j.clinre.2020.07.025
Abstrakt: 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.
(Copyright © 2020 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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