Vaishnav Manas, Elhence Anshuman, Kumar Ramesh, Mohta Srikant, Palle Chandan, Kumar Peeyush, Ranjan Mukesh, Vajpai Tanmay, Prasad Shubham, Yegurla Jatin, Dhooria Anugrah, Banyal Vikas, Agarwal Samagra, Bansal Rajat, Bhattacharjee Sulagna, Aggarwal Richa, Soni Kapil D, Rudravaram Swetha, Singh Ashutosh K, Altaf Irfan, Choudekar Avinash, Mahapatra Soumya J, Gunjan Deepak, Kedia Saurabh, Makharia Govind, Trikha Anjan, Garg Pramod, Saraya Anoop
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Department of Gastroenterology, All India Institute of Medical Sciences, Patna, India.
J Clin Exp Hepatol. 2021 May-Jun;11(3):327-333. doi: 10.1016/j.jceh.2020.09.007. Epub 2020 Oct 3.
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.
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.
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.
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.
背景/目的：在对冠状病毒病2019（COVID-19）患者进行胃肠（GI）出血管理方面，由于担心内镜检查过程中的传播风险，相关数据匮乏。我们旨在研究COVID-19患者GI出血的保守治疗结果。
在这项回顾性分析中，纳入了2020年4月22日至7月22日期间1342例COVID-19患者中出现GI出血的24例（1.8%）。
患者的平均年龄为45.8±12.7岁；17例（70.8%）为男性；上消化道（UGI）出血：下消化道（LGI）出血为23:1。22例（91.6%）患者有肝硬化证据——21例表现为UGI出血，1例为痔疮出血。2例无肝硬化患者推测为非静脉曲张性出血。UGI出血的药物治疗包括17例（73.9%）患者使用血管收缩剂——生长抑素，4例（17.4%）患者使用特利加压素。所有UGI出血患者均接受质子泵抑制剂和抗生素治疗。分别有14例（60.9%）、3例（13.0%）和3例（13.0%）患者输注了浓缩红细胞（PRBCs）、新鲜冰冻血浆（FFPs）和血小板。输注PRBCs的中位数为1（0 - 3）单位。所有23例UGI出血患者均实现了初始止血控制，无一例需要紧急内镜检查。在5天随访时，无一例再出血或死亡。2例患者后来再出血，1例因胃窦血管扩张出现间歇性出血，另1例在出院后19天再出血。3例（12.5%）肝硬化患者在住院期间死于急性低氧性呼吸衰竭。
包括药物治疗、限制性输血策略和密切血流动力学监测在内的保守管理策略可以成功管理COVID-19患者的GI出血，并减少紧急内镜检查的需求。内镜检查的决策应由多学科团队根据患者的病情、治疗反应、资源和所涉及的风险，逐案考虑后做出。
