Outcome of Conservative Therapy in COVID-19 Patients Presenting with Gastrointestinal Bleeding

Abstract

Background: There is a paucity of data on the management of gastrointestinal(GI) bleeding in patients with 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 22ndApril to 22ndJuly 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 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.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

No funding was received for this study.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Institutional Ethics Committee, All India Institute of Medical Sciences, India (Ref No: IEC-253/17.04.2020)

All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

All data regarding the study is available with the corresponding author.

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