Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding

Autor: Anugrah Dhooria, Manas Vaishnav, Chandan Palle, Vikas Banyal, Avinash Choudekar, Mukesh Ranjan, Ashutosh Singh, Soumya Jagannath Mahapatra, Anshuman Elhence, Ramesh Kumar, Sulagna Bhattacharjee, Richa Aggarwal, Anjan Trikha, Samagra Agarwal, Anoop Saraya, Deepak Gunjan, Jatin Yegurla, Govind K. Makharia, Kapil Dev Soni, Irfan Altaf, Rajat Bansal, Srikant Mohta, Shalimar, Tanmay Vajpai, Pramod Kumar Garg, Shubham Prasad, Saurabh Kedia, Peeyush Kumar, Swetha Rudravaram
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Proton pump inhibitors
GI
Gastrointestinal
HVPG
Hepatic venous pressure gradient
0302 clinical medicine
GBS
Glasgow-Blatchford bleeding score
Liver transplant
Variceal bleeding
Gastric antral vascular ectasia
Prognosis
FFP
Fresh frozen plasma
030220 oncology & carcinogenesis
CLD
Chronic liver disease
AIMS65
Albumin
Original Article
030211 gastroenterology & hepatology
INR
International normalized ratio
Fresh frozen plasma
medicine.drug
HE
Hepatic encephalopathy
medicine.medical_specialty
Gastrointestinal bleeding
NSAIDs
Non-steroidal anti-inflammatory drugs
international normalized ratio
mental status
MOHFW
Ministry of Health and Family Welfare
03 medical and health sciences
Pharmacotherapy
Hemorrhoids
COVID-19
Coronavirus disease −2019
medicine
PPE
Personal protective equipment
Hepatology
CRS
Clinical Rockall Score
GAVE
Gastric antral vascular ectasia
business.industry
LGI
Lower gastrointestinal
Endoscopy
SARS-CoV2
Severe acute respiratory syndrome Coronavirus 2
RR
Respiratory rate
RT-PCR
Reverse transcriptase polymerase chain reaction
Bleed
medicine.disease
mGBS
Modified Glasgow-Blatchford bleeding score
systolic blood pressure
age> 65
Surgery
UGI
Upper gastrointestinal
AD
Acute decompensation
Carvedilol
AIH
Autoimmune hepatitis
PRBC
Packed red blood cells
Terlipressin
business
Packed red blood cells
Zdroj: Journal of Clinical and Experimental Hepatology
ISSN: 0973-6883
DOI: 10.1016/j.jceh.2020.09.007
Popis: Background/Objective There is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with Coronavirus disease -2019 (COVID-19) amid concerns about the risk of transmission during endoscopic procedures. We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19. Methods In this retrospective analysis, 24 of 1342 (1.8%) patients with COVID-19, presenting with GI bleeding from 22nd April to 22nd July 2020, were included. Results The mean age of patients was 45.8 ± 12.7 years; 17 (70.8%) were males; upper GI (UGI) bleeding: lower GI (LGI) 23:1. Twenty-two (91.6%) patients had evidence of cirrhosis- 21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors-somatostatin in 17 (73.9%) and terlipressin in 4 (17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells (PRBCs), fresh frozen plasma (FFPs) and platelets were transfused in 14 (60.9%), 3 (13.0%) and 3 (13.0%), respectively. The median PRBCs transfused was 1 (0–3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three (12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay. Conclusion Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy. The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patient's condition, response to treatment, resources and the risks involved, on a case to case basis.
Databáze: OpenAIRE
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