Outcome of Conservative Therapy in COVID-19 Patients Presenting with Gastrointestinal Bleeding

Shalimar, D.; Vaishnav, M.; Elhence, A.; Kumar, R.; Mohta, S.; Palle, C.; Kumar, P.; Ranjan, M.; Vajpai, T.; Prasad, S.; Yegurla, J.; Dhooria, A.; Banyal, V.; Agarwal, S.; Bansal, R.; Bhattacharjee, S.; Aggarwal, R.; Soni, K. D.; Rudravaram, S.; Singh, A. K.; Altaf, I.; Choudekar, A.; Mahapatra, S. J.; Gunjan, D.; Kedia, S.; Makharia, G.; Trikha, A.; Garg, P.; Saraya, A.

Background: There is a paucity of data on the management of gastrointestinal(GI) bleeding in patients with 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 22ndApril to 22ndJuly 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) 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 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.