ABSTRACT
Introduction: The novel coronavirus disease 2019 (COVID-19) has been reported to affect the gastrointestinal system with a variety of symptoms, including gastrointestinal bleeding. The prevalence of bleeding in these patients remains unclear. Aims & Methods: The aim of this meta-analysis is to estimate the rate of gastrointestinal bleeding in COVID-19 patients. MEDLINE and Embase were searched through December 20th, 2020. Studies reporting COVID-19 patients with and without gastrointestinal bleeding were included. Estimated prevalence with 95% confidence intervals (CI) was pooled;heterogeneity was expressed as I2. Meta-regression analysis was performed to assess the impact of confounding covariates. Results: Ten studies met the inclusion criteria and were included in the analysis. A total of 91887 COVID-19 patients were considered, of whom 534 reported gastrointestinal bleeding (0.6%) [409 (76.6%) upper and 121 (22.7%) lower gastrointestinal bleeding (UGIB and LGIB, respectively)]. The overall pooled bleeding rate was 5% [95%CI 2-8], with high heterogeneity (I2 99.2%);small study effect was observed using the Egger test (p=0.049). After removing two outlier studies, the pooled bleeding rate was 2% [95%CI 0-4], with high heterogeneity (I2 99.2%), and no small study effect (p=0.257). The pooled UGIB rate was 1% (95%CI 0-3, I2 98.6%, p=0.214), whereas the pooled LGIB rate was 1% (95%CI 0-2, I2 64.7%, p=0.919). Meta regression analysis showed that overall estimates on GI bleeding were affected by studies reporting different source of bleeding. Conclusion: In this meta-analysis of published studies, individuals with COVID-19 were found to be at risk for gastrointestinal bleeding, especially upper gastrointestinal bleeding.