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

  1. DM Shalimar
  2. Manas Vaishnav
  3. Anshuman Elhence
  4. Ramesh Kumar
  5. Srikant Mohta
  6. Chandan Palle
  7. Peeyush Kumar
  8. Mukesh Ranjan
  9. Tanmay Vajpai
  10. Shubham Prasad
  11. Jatin Yegurla
  12. Anugrah Dhooria
  13. Vikas Banyal
  14. Samagra Agarwal
  15. Rajat Bansal
  16. Sulagna Bhattacharjee
  17. Richa Aggarwal
  18. Kapil Dev Soni
  19. Swetha Rudravaram
  20. Ashutosh Kumar Singh
  21. Irfan Altaf
  22. Avinash Choudekar
  23. Soumya Jagannath Mahapatra
  24. Deepak Gunjan
  25. Saurabh Kedia
  26. Govind Makharia
  27. Anjan Trikha
  28. Pramod Garg
  29. Anoop Saraya
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Abstract

Background/Objective

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 22 April to 22 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 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.

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