Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding.
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
Journal
Journal of clinical and experimental hepatology
ISSN: 0973-6883
Titre abrégé: J Clin Exp Hepatol
Pays: India
ID NLM: 101574137
Informations de publication
Date de publication:
Historique:
received:
09
08
2020
accepted:
28
09
2020
pubmed:
2
2
2021
medline:
2
2
2021
entrez:
1
2
2021
Statut:
ppublish
Résumé
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. 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. 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 (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. 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.
Sections du résumé
BACKGROUND/OBJECTIVE
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
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
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 (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
CONCLUSIONS
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.
Identifiants
pubmed: 33519132
doi: 10.1016/j.jceh.2020.09.007
pii: S0973-6883(20)30146-8
pmc: PMC7833290
doi:
Types de publication
Journal Article
Langues
eng
Pagination
327-333Informations de copyright
© 2020 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.
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