Department of General Surgery, Division of Gastroenterologic Surgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara-Turkey.
Department of Anesthesiology and Reanimation, University of Health Sciences, Gülhane Training and Research Hospital, Ankara-Turkey.
Ulus Travma Acil Cerrahi Derg. 2022 Jun;28(6):762-768. doi: 10.14744/tjtes.2021.30513.
Upper gastrointestinal system bleeding (UGIB) that occurs with the effect of coagulopathy due to COVID-19 disease itself and drugs such as LMWH and steroids used in the treatment negatively affects the outcomes. In this study, we aimed to examine the frequency of gastrointestinal system bleeding in COVID-19 patients, risk factors, effect on outcomes, and management.
Institutional center (a third-level pandemic center) database was searched for patients hospitalized for COVID-19 between March 11, 2020, and December 17, 2020, retrospectively. Patients with UGIB symptoms/signs were included in the study. Age, gender, body mass index (kg/m2), hospital department where bleeding was diagnosed, previous bleeding history, comorbidities, and medication were steroid, anticoagulant, low weight molecule heparin, and proton-pomp inhibitor, endoscopic findings/treatment, transfusion, and mortality rates were evaluated. Patients were divided into two groups as survivors and non-survivors and parameters were compared.
Forty-five of a total 5484 patients under COVID-19 treatment had upper gastrointestinal bleeding (0.8%). The average age of the patients was 70.1 years and 73% bleeders were male. Nineteen patients (44%) underwent endoscopy. The most common etiologies of bleeding were gastric/duodenal ulcer (n=9), erosive gastritis (n=4), and hemorrhagic gastritis (n=3). Active bleeding re-quiring intervention was detected in only one patient; therapeutic band ligation was applied to only 1 (2%) of all patients. The most common etiologies of bleeding were gastric/duodenal ulcer (n=9), erosive gastritis (n=4), and hemorrhagic gastritis (n=3). In terms of statistical significance, it was observed that the rate of steroid treatment (77% vs. 39%) and the number of days of steroid treatment were higher in non-survivor group.
UGIB is less common in COVID-19 patients compared to other hospitalized patients. However, it significantly increases mortality. Mortality risk increases even more in patients using steroids. These risks should be considered in patients under COVID-19 treatment. The majority of the bleeding patients does not require endoscopic treatment and should be managed conser-vatively. It is worth considering reducing unnecessary endoscopies in the pandemic.
由于 COVID-19 疾病本身以及在治疗中使用的低分子肝素和类固醇等药物引起的凝血功能障碍，导致上消化道系统出血（UGIB），这对结果产生负面影响。在这项研究中，我们旨在检查 COVID-19 患者胃肠道出血的频率、危险因素、对结果的影响以及治疗方法。
回顾性检索 2020 年 3 月 11 日至 2020 年 12 月 17 日期间因 COVID-19 住院的患者的机构中心（三级大流行中心）数据库。将有 UGIB 症状/体征的患者纳入研究。评估年龄、性别、体重指数（kg/m2）、出血诊断所在的医院科室、既往出血史、合并症和药物（皮质类固醇、抗凝剂、低分子量肝素和质子泵抑制剂）、内镜检查结果/治疗、输血和死亡率。患者分为存活组和非存活组，并比较参数。
在 5484 名接受 COVID-19 治疗的患者中，有 45 名（0.8%）出现上消化道出血。患者的平均年龄为 70.1 岁，73%的出血者为男性。19 名患者（44%）接受了内镜检查。最常见的出血病因是胃/十二指肠溃疡（n=9）、糜烂性胃炎（n=4）和出血性胃炎（n=3）。仅 1 名患者（2%）发现有活动性出血需要干预；仅对 1 名患者（2%）应用了治疗性带结扎。最常见的出血病因是胃/十二指肠溃疡（n=9）、糜烂性胃炎（n=4）和出血性胃炎（n=3）。在统计学意义上，非存活组的皮质类固醇治疗率（77% vs. 39%）和皮质类固醇治疗天数更高。
与其他住院患者相比，COVID-19 患者的 UGIB 较少见。然而，它显著增加了死亡率。在使用类固醇的患者中，死亡风险增加更多。在 COVID-19 治疗患者中应考虑这些风险。大多数出血患者不需要内镜治疗，应保守治疗。在大流行期间，考虑减少不必要的内镜检查是值得的。
