Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding.
J Clin Exp Hepatol
; 11(3): 327-333, 2021.
Article
in English
| MEDLINE | ID: covidwho-909239
Preprint
This scientific journal article is probably based on a previously available preprint. It has been identified through a machine matching algorithm, human confirmation is still pending.
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This scientific journal article is probably based on a previously available preprint. It has been identified through a machine matching algorithm, human confirmation is still pending.
See preprint
ABSTRACT
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.METHODS:
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.RESULTS:
The mean age of patients was 45.8 ± 12.7 years; 17 (70.8%) were males; upper GI (UGI) bleeding lower GI (LGI) 231. 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.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.
AD, Acute decompensation; AIH, Autoimmune hepatitis; AIMS65, Albumin, international normalized ratio, mental status, systolic blood pressure, age > 65; CLD, Chronic liver disease; COVID-19, Coronavirus disease −2019; CRS, Clinical Rockall Score; Carvedilol; Endoscopy; FFP, Fresh frozen plasma; GAVE, Gastric antral vascular ectasia; GBS, Glasgow-Blatchford bleeding score; GI, Gastrointestinal; HE, Hepatic encephalopathy; HVPG, Hepatic venous pressure gradient; INR, International normalized ratio; LGI, Lower gastrointestinal; Liver transplant; MOHFW, Ministry of Health and Family Welfare; NSAIDs, Non-steroidal anti-inflammatory drugs; PPE, Personal protective equipment; PRBC, Packed red blood cells; Prognosis; Proton pump inhibitors; RR, Respiratory rate; RT-PCR, Reverse transcriptase polymerase chain reaction; SARS-CoV2, Severe acute respiratory syndrome Coronavirus 2; UGI, Upper gastrointestinal; Variceal bleeding; mGBS, Modified Glasgow-Blatchford bleeding score
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Language:
English
Journal:
J Clin Exp Hepatol
Year:
2021
Document Type:
Article
Affiliation country:
J.jceh.2020.09.007
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