Division of Gastroenterology, Department of Medicine, Aleda E. Lutz Veterans Hospital at Saginaw, Main Building, Room 3212, 1500 Weiss Street, Saginaw, MI 48602, USA.
Division of Therapeutic Endoscopy, Division of Gastroenterology, Department of Medicine, New York University Langone Hospital, 259 1st Street, Mineola, NY 11501, USA.
Gastroenterol Clin North Am. 2023 Mar;52(1):77-102. doi: 10.1016/j.gtc.2022.10.004. Epub 2022 Nov 1.
COVID-19 infection is an ongoing catastrophic global pandemic with significant morbidity and mortality that affects most of the world population. Respiratory manifestations predominate and largely determine patient prognosis, but gastrointestinal (GI) manifestations also frequently contribute to patient morbidity and occasionally affect mortality. GI bleeding is usually noted after hospital admission and is often one aspect of this multisystem infectious disease. Although the theoretical risk of contracting COVID-19 from GI endoscopy performed on COVID-19-infected patients remains, the actual risk does not seem to be high. The introduction of PPE and widespread vaccination gradually increased the safety and frequency of performing GI endoscopy in COVID-19-infected patients. Three important aspects of GI bleeding in COVID-19-infected patients are (1) GI bleeding is often from mucosal erosions from mucosal infalammation that causes mild GI bleeding; (2) severe upper GI bleeding is often from PUD or stress gastritis from COVID-19 pneumonia; and (3) lower GI bleeding frequently arises from ischemic colitis associated with thromboses and hypercoagulopathy from COVID-19 infection. The literature concerning GI bleeding in COVID-19 patients is presently reviewed.
COVID-19 感染是一种持续的灾难性全球大流行,发病率和死亡率都很高,影响了世界上大多数人口。呼吸道表现占主导地位,在很大程度上决定了患者的预后,但胃肠道(GI)表现也经常导致患者发病,偶尔影响死亡率。GI 出血通常在住院后出现,并且常常是这种多系统传染病的一个方面。尽管从 COVID-19 感染患者进行的胃肠内镜检查中感染 COVID-19 的理论风险仍然存在,但实际风险似乎并不高。个人防护装备(PPE)的引入和广泛接种疫苗逐渐提高了 COVID-19 感染患者进行胃肠内镜检查的安全性和频率。COVID-19 感染患者中 GI 出血的三个重要方面是:(1)GI 出血通常是由黏膜炎症引起的黏膜糜烂引起的轻度 GI 出血;(2)严重的上 GI 出血通常是由 COVID-19 肺炎引起的 PUD 或应激性胃炎引起的;(3)下 GI 出血常由 COVID-19 感染引起的血栓形成和高凝状态相关的缺血性结肠炎引起。目前对 COVID-19 患者 GI 出血的文献进行了回顾。