Upper Gastrointestinal Bleeding Caused by SARS-CoV-2 Infection

Li, Xiaofeng; Huang, Shenlin; Lü, Jing; Lai, Renxu; Zhang, Zhenyi; Lin, Xianqi; Zheng, Xiaobin; Shan, Hong

doi:10.14309/ajg.0000000000000757

Cited by 22 publications

(22 citation statements)

References 6 publications

(6 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Limited data are available regarding the outcomes of GIB in these patients, and the evidence is limited to small observational studies, case series, and case reports. [11][12][13][14][15][16][17][18][19][20][21] Therefore, we performed a systematic review and meta-analysis to evaluate the etiology, management, and outcomes of COVID-19 patients who had signs and symptoms of GIB.…”

Section: Introductionmentioning

confidence: 99%

Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

Background/Aims: More than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and metaanalysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB). Methods: A systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB. Results: Our search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%-9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%-18.4%). Conclusion:The majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful. Clin Endosc 2021 Jun 25.

show abstract

Section: Introductionmentioning

confidence: 99%

Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Similar to our patient, this patient was also an elderly man who presented with ventilator-dependent respiratory insufficiency with resultant gastrointestinal bleeding. 19 The classic endoscopic appearance of a black circumferential area was not present in our case, although there was extensive necrosis extending into the muscularis propria on histology. This is possibly because of the timing of the endoscopy, which occurred approximately a month after discharge from the initial period of illness.…”

Section: Discussionmentioning

confidence: 51%

Acute oesophageal necrosis in a patient with recent SARS-CoV-2

et al. 2021

View full text Add to dashboard Cite

A 57-year-old Hispanic man with diabetes presented with dyspnoea. He had a positive SARS-CoV-2 PCR. He was intubated for severe hypoxia and treated with intermittent pressors, methylprednisolone and supportive care. He was extubated on hospital day (HD) 9 and discharged to a skilled nursing facility (SNF) on HD 18. Approximately 1 month later, he presented with melena. Endoscopy revealed two large 1.5–2 cm wide-based distal oesophageal ulcers without active bleeding. Histology showed ulcerated squamous mucosa with extensive necrosis extending to the muscularis propria and coccoid bacterial colonies with rare fungal forms suggestive of Candida. He was treated with fluconazole and pantoprazole and was discharged to a SNF. Approximately 3 weeks later, he was readmitted for complications. Repeat endoscopy demonstrated improvement and histology revealed chronic inflammation with reactive epithelial changes. Incidentally, SARS-CoV-2 PCR was positive during this visit without any respiratory symptoms.

show abstract

“…They also reported neutrophilic infiltration due to secondary bacterial infection. Lymphocytic infiltration has also been described in biopsy of a COVID-19-associated esophageal ulcer (10). Specific immunohistochemical analyses for SARS-CoV-2 were not performed in the above cases.…”

Section: Discussionmentioning

confidence: 99%

“…In COVID-19, ulcerative lesions have been reported in various segments of the gastrointestinal (GI) tract, namely the tongue, hard/soft palate, labial and buccal mucosa, [e.g. (1)(2)(3)(4)(5)(6)(7)(8)], oropharynx (3), esophagus (9,10), stomach/duodenum (11,12) and large bowel (13).…”

Section: Introductionmentioning

confidence: 99%

Hypopharyngeal Ulcers in COVID-19: Histopathological and Virological Analyses – A Case Report

et al. 2021

View full text Add to dashboard Cite

In coronavirus disease 2019 (COVID-19), ulcerative lesions have been episodically reported in various segments of the gastrointestinal (GI) tract, including the oral cavity, oropharynx, esophagus, stomach and bowel. In this report, we describe an autopsy case of a COVID-19 patient who showed two undiagnosed ulcers at the level of the anterior and posterior walls of the hypopharynx. Molecular testing of viruses involved in pharyngeal ulcers demonstrated the presence of severe acute respiratory syndrome – coronavirus type 2 (SARS-CoV-2) RNA, together with herpes simplex virus 1 DNA. Histopathologic analysis demonstrated full-thickness lympho-monocytic infiltration (mainly composed of CD68-positive cells), with hemorrhagic foci and necrosis of both the mucosal layer and deep skeletal muscle fibers. Fibrin and platelet microthrombi were also found. Cytological signs of HSV-1 induced damage were not found. Cells expressing SARS-CoV-2 spike subunit 1 were immunohistochemically identified in the inflammatory infiltrations. Immunohistochemistry for HSV1 showed general negativity for inflammatory infiltration, although in the presence of some positive cells. Thus, histopathological, immunohistochemical and molecular findings supported a direct role by SARS-CoV-2 in producing local ulcerative damage, although a possible contributory role by HSV-1 reactivation cannot be excluded. From a clinical perspective, this autopsy report of two undiagnosed lesions put the question if ulcers along the GI tract could be more common (but frequently neglected) in COVID-19 patients.

show abstract

Upper Gastrointestinal Bleeding Caused by SARS-CoV-2 Infection

Cited by 22 publications

References 6 publications

Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

Acute oesophageal necrosis in a patient with recent SARS-CoV-2

Hypopharyngeal Ulcers in COVID-19: Histopathological and Virological Analyses – A Case Report

Contact Info

Product

Resources

About