Ulcers most common cause of gastrointestinal bleeding in COVID-19 patients

Initial presenting symptoms do not differ between coronavirus disease (COVID-19) patients with and without gastrointestinal bleeding (GIB), a recent study has found. In addition, peptic ulcer disease and rectal ulcers from rectal tubes are the most common aetiology of those with upper and lower GIB, respectively.

This matched case-control study included 41 COVID-19 patients with GIB (31 upper and 10 lower) and 82 matched controls of COVID-19 patients without GIB. The investigators characterized bleeding aetiologies and discussed the outcomes and therapeutic approaches involved.

No difference was observed in the presenting symptoms as well as severity of COVID-19 manifestations (p>0.05) of the cases and controls. Ten (32 percent) patients with upper GIB underwent esophagogastroduodenoscopy, and five (50 percent) with lower GIB underwent flexible sigmoidoscopy or colonoscopy.

The most common aetiologies were gastric or duodenal ulcers (80 percent) for upper GIB and rectal ulcers related to rectal tubes (60 percent) for lower GIB. Of the esophagogastroduodenoscopies, four resulted in therapeutic intervention. Three patients with rectal ulcers were subsequently referred to colorectal surgery for rectal packing.

Seven patients who required interventions achieved successful haemostasis. Transfusion requirements did not significant differ between patients who underwent endoscopic therapy and those who were conservatively managed.

Notably, anticoagulation and rectal tube usage appeared to increase the risk for GIB, but the association did not reach statistical significance.

“Conservative management seems to be a reasonable initial approach in managing these complex cases, but larger studies are needed to guide management,” the investigators said.