Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding
© 2020 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
Journal of clinical and experimental hepatology - 11(2021), 3 vom: 05. Mai, Seite 327-333 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Shalimar [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Revised 22.04.2022 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.jceh.2020.09.007 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM320803392 |
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| 100 | 1 | |a Shalimar |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Revised 22.04.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2020 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a AD, Acute decompensation | |
| 650 | 4 | |a AIH, Autoimmune hepatitis | |
| 650 | 4 | |a AIMS65, Albumin, international normalized ratio, mental status, systolic blood pressure, age > 65 | |
| 650 | 4 | |a CLD, Chronic liver disease | |
| 650 | 4 | |a COVID-19, Coronavirus disease −2019 | |
| 650 | 4 | |a CRS, Clinical Rockall Score | |
| 650 | 4 | |a Carvedilol | |
| 650 | 4 | |a Endoscopy | |
| 650 | 4 | |a FFP, Fresh frozen plasma | |
| 650 | 4 | |a GAVE, Gastric antral vascular ectasia | |
| 650 | 4 | |a GBS, Glasgow-Blatchford bleeding score | |
| 650 | 4 | |a GI, Gastrointestinal | |
| 650 | 4 | |a HE, Hepatic encephalopathy | |
| 650 | 4 | |a HVPG, Hepatic venous pressure gradient | |
| 650 | 4 | |a INR, International normalized ratio | |
| 650 | 4 | |a LGI, Lower gastrointestinal | |
| 650 | 4 | |a Liver transplant | |
| 650 | 4 | |a MOHFW, Ministry of Health and Family Welfare | |
| 650 | 4 | |a NSAIDs, Non-steroidal anti-inflammatory drugs | |
| 650 | 4 | |a PPE, Personal protective equipment | |
| 650 | 4 | |a PRBC, Packed red blood cells | |
| 650 | 4 | |a Prognosis | |
| 650 | 4 | |a Proton pump inhibitors | |
| 650 | 4 | |a RR, Respiratory rate | |
| 650 | 4 | |a RT-PCR, Reverse transcriptase polymerase chain reaction | |
| 650 | 4 | |a SARS-CoV2, Severe acute respiratory syndrome Coronavirus 2 | |
| 650 | 4 | |a UGI, Upper gastrointestinal | |
| 650 | 4 | |a Variceal bleeding | |
| 650 | 4 | |a mGBS, Modified Glasgow-Blatchford bleeding score | |
| 700 | 1 | |a Vaishnav, Manas |e verfasserin |4 aut | |
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