Effect of the Coronavirus 2019 Pandemic on Outcomes for Patients Admitted With Gastrointestinal Bleeding in New York City

Extrapulmonary manifestations of COVID-19

“…Most practitioners reserve procedures for patients with COVID-19 to those for whom therapeutic intervention is necessary due to large-volume upper gastrointestinal bleeding or biliary obstruction. During the COVID-19 pandemic at a New York City hospital, upper endoscopy was performed at lower-than-usual hemoglobin levels and after transfusion of larger volumes of packed red blood cells 168 . Interestingly, this was seen both in patients testing positive for SARS-CoV-2 and in those testing negative, probably reflective of a reluctance to perform endoscopy for the former group and reluctance of the latter group to come to the hospital.…”

Haemoglobin oxygen affinity in patients with severe COVID‐19 infection: Still unclear

“…On the contrary, measures that increase haemoglobin's oxygen affinity improve the oxygenation values in pre-ARDS patients: (i) hyperventilation shifts the oxyhaemoglobin dissociation curve (ODC) to the left increasing the saturation. Therefore, an increase in arterial carbon dioxide tension (PaCO 2 ) will lead to a right shift of the ODC, resulting in an abrupt fall in SO 2 and a risk of circulatory collapse in critically ill patients; 4 (ii) transfusion of red blood cells may be justified as a therapeutic adjuvant in critically ill COVID-19 patients, 5,6,7,8 because stored haemoglobin is maintained for a long time in its quaternary R (relax) state with high Hb affinity to O 2 by decreasing 2,3-diphosphoglycerate concentration; (iii) current smokers, although more likely to become infected, develop a lower percentage of clinically significant COVID-19 symptoms than non-smokers. 9,10 This can be expected, since the high carboxyhaemoglobin levels in nicotine or non-nicotine cigarette smokers (5-15%) 11,12 favour the haemoglobin R-state with increased Hb-O2 affinity; and (iv) 5-hydroxymethylfurfural (5-HMF) is an agent capable of shifting the ODC to the left.…”

COVID-19 in patients with IBD and pancreaticobiliary disorders

“…For example, in one US study, patients with GI bleeding were found to have significantly lower odds of undergoing endoscopy compared with patients admitted before the pandemic. 31 In Hong Kong, while procedural volumes were reduced by more than 50%, the number of new GI cancer diagnoses decreased by 49.1%. 32 The impact of COVID-19 on deferred care is substantial and the consequences will likely be realized for years.…”