Gastrointestinal Bleeding in COVID-19 Patients

Negro, Alessandra; Villa, Giulia; Rolandi, Stefano; Lucchini, Alberto; Bambi, Stefano

doi:10.1097/sga.0000000000000676

Cited by 10 publications

(14 citation statements)

References 57 publications

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“…Bleeding and ischemic manifestations are also frequent, with spontaneous hematomas in soft tissues being the most common. Ischemic and hemorrhagic abdominal complications such as ischemic colitis, small bowel ischemia, retroperitoneal bleeding and others may occur in patients with COVID-19 [ 14 – 19 ]. The overall rate of gastrointestinal bleeding in patients with COVID-19 reportedly ranged from 1.1 to 13%, with most patients with gastrointestinal bleeding being critically ill men with a mean age of 67.5 years [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ischemic and hemorrhagic abdominal complications such as ischemic colitis, small bowel ischemia, retroperitoneal bleeding and others may occur in patients with COVID-19 [ 14 – 19 ]. The overall rate of gastrointestinal bleeding in patients with COVID-19 reportedly ranged from 1.1 to 13%, with most patients with gastrointestinal bleeding being critically ill men with a mean age of 67.5 years [ 14 ]. COVID-19-induced colitis that presents with abdominal pain, watery diarrhea and gastrointestinal bleeding consistent with an acute hemorrhagic colitis was reported as an uncommon occurrence [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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A descriptive study of abdominal complications in patients with mild COVID-19 presenting to the emergency department: a single-center experience in Japan during the omicron variant phase

et al. 2023

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Background COVID-19 is widely known to induce a variety of extrapulmonary manifestations. Gastrointestinal symptoms have been identified as the most common extra-pulmonary manifestations of COVID-19, with an incidence reported to range from 3 to 61%. Although previous reports have addressed abdominal complications with COVID-19, these have not been adequately elucidated for the omicron variant. The aim of our study was to clarify the diagnosis of concomitant abdominal diseases in patients with mild COVID-19 who presented to hospital with abdominal symptoms during the sixth and seventh waves of the pandemic of the omicron variant in Japan. Methods This study was a retrospective, single-center, descriptive study. In total, 2291 consecutive patients with COVID-19 who visited the Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, Osaka, Japan, between January 2022 and September 2022 were potentially eligible for the study. Patients delivered by ambulance or transferred from other hospitals were not included. We collected and described physical examination results, medical history, laboratory data, computed tomography findings and treatments. Data collected included diagnostic characteristics, abdominal symptoms, extra-abdominal symptoms and complicated diagnosis other than that of COVID-19 for abdominal symptoms. Results Abdominal symptoms were present in 183 patients with COVID-19. The number of patients with each abdominal symptom were as follows: nausea and vomiting (86/183, 47%), abdominal pain (63/183, 34%), diarrhea (61/183, 33%), gastrointestinal bleeding (20/183, 11%) and anorexia (6/183, 3.3%). Of these patients, 17 were diagnosed as having acute hemorrhagic colitis, five had drug-induced adverse events, two had retroperitoneal hemorrhage, two had appendicitis, two had choledocholithiasis, two had constipation, and two had anuresis, among others. The localization of acute hemorrhagic colitis was the left-sided colon in all cases. Conclusions Our study showed that acute hemorrhagic colitis was characteristic in mild cases of the omicron variant of COVID-19 with gastrointestinal bleeding. When examining patients with mild COVID-19 with gastrointestinal bleeding, the potential for acute hemorrhagic colitis should be kept in mind.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A descriptive study of abdominal complications in patients with mild COVID-19 presenting to the emergency department: a single-center experience in Japan during the omicron variant phase

et al. 2023

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“…The underlying mechanisms for why spike protein causes such clinical pathogenesis remain to be further explored. Moreover, mucosal damage, which is one of the most important pathological changes, was found to be common among different organs ( 49 ).…”

Section: Discussionmentioning

confidence: 99%

Spatiotemporal observations of host-pathogen interactions in mucosa during SARS-CoV-2 infection indicate a protective role of ILC2s

Hu,

Meng,

Wang

et al. 2023

Microbiol Spectr

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Innate lymphoid cells (ILCs) play a crucial role in mucosal protection and tissue homeostasis. However, the early mucosal defense mechanisms against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus have not been fully understood to date. This knowledge gap has motivated us to develop a coronavirus disease 2019-like mouse model to investigate the interactions between the virus, its receptor, and ILCs. In our study, we conducted intranasal challenges using pseudovirus expressing Spike (PSV-S) to examine the expression patterns of humanized ACE2 (chiACE2) and the transduction of PSV-S in lung and ileum tissues over a specified time period. Within a span of 72 hours, we observed an intense viral transduction induced by the spike protein, which was detected from the central bronchus to the bronchiole and alveolus in the lung (levels 3 to 8). Similarly, we observed the transduction of PSV-S in the villi and crypts of the ileum. Interestingly, our precise three-dimensional colocalization analysis revealed that only 73.74% ± 1.76% of the PSV-S transduction depended on chiACE2. Furthermore, type 2 innate lymphoid cells (ILC2s) exhibited the most pronounced activation in the gut mucosa. This finding indicates the significant role of ILC2s as contributors to the mucosal defense against viral infections. Our data shed light on the critical involvement of ILC2s and their intricate three-dimensional regulatory network in combating SARS-CoV-2 within the mucosa. IMPORTANCE Our study revealed the spatial interaction between humanized ACE2 and pseudovirus expressing Spike, emphasizing the role of type 2 innate lymphoid cells during the initial phase of viral infection. These findings provide a foundation for the development of mucosal vaccines and other treatment approaches for both pre- and post-infection management of coronavirus disease 2019.

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“…These factors may increase the risk of bleeding and subsequent mortality in patients with UGIB. Furthermore, the COVID-19 pandemic may have interrupted healthcare systems, resulting in delayed or inadequate care for patients with UGIB [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Trends of Upper Gastrointestinal Bleeding Mortality in the United States Before and During the COVID-19 Era: Estimates From the Centers for Disease Control WONDER Database

Merza¹,

Masoud²,

Ahmed³

et al. 2023

Gastroenterol Res

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Background: There have been reports of increased upper gastrointestinal bleeding (UGIB) in patients with coronavirus disease 2019 . Still, only a few studies have examined the mortality rate associated with UGIB in the United States before and during COVID-19. Hereby, we explored the trends of UGIB mortality in the United States before and during COVID-19. The study's objective was to investigate whether the COVID-19 pandemic significantly impacted UGIB mortality rates in the USA. Methods:The decedents with UGIB were included. Age-standardized mortality rates were estimated with the indirect method using the 2000 US Census as the standard population. We utilized the deidentified data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Linear regression analysis was performed to determine 2021 projected mortality rates based on trends between 2012 and 2019 to quantify the association of the pandemic with UGIB-related deaths. Results:The mortality rate increased from 3.3 per 100,000 to 4.3 per 100,000 among the population between 2012 and 2021. There was a significant increase in the overall mortality rate between each year and the following year from 2012 to 2019, ranging from 0.1 to 0.2 per 100,000, while the rise in the overall mortality rate between each year and 2021 ranges from 0.4 to 0.9 per 100,000. Conclusions:Our results showed that the mortality rate increased among the population between 2012and 2021, suggesting a possible influence of COVID-19 infection on the incidence and mortality of UGIB.

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Gastrointestinal Bleeding in COVID-19 Patients

Cited by 10 publications

References 57 publications

A descriptive study of abdominal complications in patients with mild COVID-19 presenting to the emergency department: a single-center experience in Japan during the omicron variant phase

A descriptive study of abdominal complications in patients with mild COVID-19 presenting to the emergency department: a single-center experience in Japan during the omicron variant phase

Spatiotemporal observations of host-pathogen interactions in mucosa during SARS-CoV-2 infection indicate a protective role of ILC2s

Trends of Upper Gastrointestinal Bleeding Mortality in the United States Before and During the COVID-19 Era: Estimates From the Centers for Disease Control WONDER Database

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