Gastrointestinal Bleeding in COVID-19-Infected Patients

• Published in: Gastroenterology clinics of North America Vol. 52; no. 1; p. 77
• Main Authors: Cappell, Mitchell S, Friedel, David M
• Format: Journal Article
• Language: English
• Published: United States 01.03.2023
• Subjects: COVID-19 - complications; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage - etiology; Humans; Prognosis; COVID-19; Esophagogastroduodenoscopy; Therapeutic endoscopy; Endoscopy safety; Gastrointestinal bleeding; Colonoscopy; Pandemic; SARS
• ISSN: 1558-1942
• DOI: 10.1016/j.gtc.2022.10.004

COVID-19 infection is an ongoing catastrophic global pandemic with significant morbidity and mortality that affects most of the world population. Respiratory manifestations predominate and largely determine patient prognosis, but gastrointestinal (GI) manifestations also frequently contribute to patient morbidity and occasionally affect mortality. GI bleeding is usually noted after hospital admission and is often one aspect of this multisystem infectious disease. Although the theoretical risk of contracting COVID-19 from GI endoscopy performed on COVID-19-infected patients remains, the actual risk does not seem to be high. The introduction of PPE and widespread vaccination gradually increased the safety and frequency of performing GI endoscopy in COVID-19-infected patients. Three important aspects of GI bleeding in COVID-19-infected patients are (1) GI bleeding is often from mucosal erosions from mucosal infalammation that causes mild GI bleeding; (2) severe upper GI bleeding is often from PUD or stress gastritis from COVID-19 pneumonia; and (3) lower GI bleeding frequently arises from ischemic colitis associated with thromboses and hypercoagulopathy from COVID-19 infection. The literature concerning GI bleeding in COVID-19 patients is presently reviewed.