Upper gastrointestinal bleeding in COVID-19 inpatients: Incidence and management in a multicenter experience from Northern Italy

Aurelio, Mauro; Federico, De Grazia; Vincenzo, Lenti Marco; Roberto, Penagini; Roberto, Frego; Sandro, Ardizzone; Edoardo, Savarino; Franco, Radaelli; Matteo, Bosani; Stefania, Orlando; Arnaldo, Amato; Marco, Dinelli; Francesca, Ferretti; Elisabetta, Filippi; Maurizio, Vecchi; Davide, Stradella; Marco, Bardone; Lodovica, Pozzi; Laura, Rovedatti; Elena, Strada; Antonio, Di Sabatino

Abstract Background COVID-19 patients have an increased susceptibility to develop thrombotic complications, thus thromboprophylaxis is warranted which may increase risk of upper gastrointestinal bleeding (UGIB). Our aim was to evaluate incidence of UGIB and use of upper GI endoscopy in COVID-19 inpatients. Methods the medical and endoscopic management of UGIB in non-ICU COVID-19 patients has been retrospectively evaluated. Glasgow Blatchford score was calculated at onset of signs of GI bleeding. Timing between onset of signs of GI bleeding and execution, if performed, of upper GI endoscopy was evaluated. Endoscopic characteristics and outcome of patients were evaluated overall or according to the execution or not of an upper GI endoscopy before and after 24 hr. Results Out of 4871 COVID-19 positive patients, 23 presented signs of UGIB and were included in the study (incidence 0.47%). The majority (78%) were on anticoagulant therapy or thromboprophylaxis. In 11 patients (48%) upper GI endoscopy was performed within 24hr, whereas it was not performed in 5. Peptic ulcer was the most common finding (8/18). Mortality rate was 21.7% for worsening of COVID-19 infection. Mortality and rebleeding were not different between patients having upper GI endoscopy before or after 24 hr/not performed. Glasgow Blatchford score was similar between the two groups (13;12-16 vs 12;9-15). Conclusion Upper GI bleeding complicated hospital stay in almost 0.5% of COVID-19 patients and peptic ulcer disease is the most common finding. Conservative management could be an option in patients that are at high risk of respiratory complications.