The frequency of ulcerative-erosive defects and ulcerative bleeding of the gastroduodenal zone in patients with coronavirus infection COVID-19

Aim: to determine the frequency of erosive and ulcerative defects and ulcerative bleeding of the gastroduodenal zone in patients with COVID-19 infection.
Materials and methods. Fibroesophagogastroduodenoscopy was performed in patients in the hospital for the COVID-19 infection treatment when they had heartburn, dyspepsia, or signs of gastrointestinal bleeding among patients. In total, endoscopy was performed in 387 patients (116 men and 271 women, mean age 65.4 years). Erosive esophagitis was assessed according to the Los Angeles classification (1994), candidiasis esophagitis according to the Kodsi classification (1976), esophageal varices according to K. J. Paquet (1983), classification of ulcerative bleeding according to J. A. Forrest (1974).
Results. Erosions in the esophagus was found in 25.3% of the examined patients, gastric and duodenal erosions—in 44.4% of persons, gastric and duodenal ulcers — in 10.1% of patients. Gastroduodenal bleeding was determined in 5.7% of the examined patients and was associated with ulcerative defects in 81.8% of cases. Male gender was a strong risk factor for erosions, ulcers, and bleeding from the upper gastrointestinal tract.
Conclusion. In patients with COVID-19, complications from the gastrointestinal tract, manifested by ulcerative defects and bleeding from the gastroduodenal zone, are a significant problem. It seems rational to propose to treat patients with COVID-19 infection receiving massive anti-inflammatory, anthrombocytic, anticoagulant therapy in the same way as is customary in the management of cardiological and rheumatological patients for the prevention of NSAID-gastropathy.

1. Tang J.W., Tambyah P. A., Hui D. S.C. Emergence of a novel coronavirus causing respiratory illness from Wuhan, China. J Infect. 2020 Mar;80(3):350–371. doi:10.1016/j.jinf.2020.01.014

2. Sotoodeh Ghorbani S., Taherpour N., Bayat S., et al. Epidemiologic characteristics of cases with reinfection, recurrence, and hospital readmission due to COVID-19: A systematic review and meta-analysis. J Med Virol. 2022;94(1):44–53. doi:10.1002/jmv.27281

3. Nobel Y.R., Phipps M., Zucker J., et al. Gastrointestinal Symptoms and Coronavirus Disease 2019: A CaseControl Study From the United States. Gastroenterology. 2020;159(1):373–375.e2. doi:10.1053/j.gastro.2020.04.017

4. Li Q., Guan X., Wu P., et al. Early Transmission Dynamics in Wuhan, China, of Novel CoronavirusInfected Pneumonia. N Engl J Med. 2020;382(13):1199–1207. doi:10.1056/NEJMoa2001316

5. Galanopoulos M., Gkeros F., Doukatas A., et al. COVID-19 pandemic: Pathophysiology and manifestations from the gastrointestinal tract. World J Gastroenterol. 2020;26(31):4579–4588. doi:10.3748/wjg.v26.i31.4579

6. Mao R., Qiu Y., He J. S., et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5(7):667–678. doi:10.1016/S2468–1253(20)30126–6

7. Sultan S., Altayar O., Siddique S. M., et al. AGA Institute Rapid Review of the Gastrointestinal and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19. Gastroenterology. 2020;159(1):320–334.e27. doi:10.1053/j.gastro.2020.05.001

8. Cheung K.S., Hung I. F.N., Chan P. P.Y., et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis. Gastroenterology. 2020;159(1):81–95. doi:10.1053/j.gastro.2020.03.065

9. Melazzini F., Lenti M. V., Mauro A., et al. Peptic Ulcer Disease as a Common Cause of Bleeding in Patients with Coronavirus Disease 2019. Am J Gastroenterol. 2020;115(7):1139–1140. doi:10.14309/ajg.0000000000000710

10. Ministry of Health of the Russian Federation. Interim Guidelines: Prevention, Diagnosis, and Treatment of Novel Coronavirus Infection (COVID-19). Version 14 (12/27/2021) (In Russ.) Available at: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/059/041/original/%D0%92%D0%9C%D0%A0_COVID-19_V14_27–12–2021.pdf Access: 01.10.2021.

11. Lundell L.R., Dent J., Bennett J. R., et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45(2):172–180. doi:10.1136/gut.45.2.172

12. Kodsi B.E., Wickremesinghe C., Kozinn P. J., et al. Candida esophagitis: a prospective study of 27 cases. Gastroenterology. 1976;71(5):715–719. PMID:964563.

13. Paquet K. J. Endoscopic paravariceal injection sclerotherapy of the esophagus – indications, technique, complications: results of a period of 14 years. Gastrointest Endosc. 1983;29(4):310–315. doi:10.1016/s0016–5107(83)72642–8

14. Forrest J.A., Finlayson N. D., Shearman D. J. Endoscopy in gastrointestinal bleeding. Lancet. 1974;2(7877):394–397. doi:10.1016/s0140–6736(74)91770-x

15. Laine L., Barkun A. N., Saltzman J. R., et al. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021;116(5):899–917. doi:10.14309/ajg.0000000000001245

16. Abrignani M.G., Gatta L., Gabrielli D., et al. Gastroprotection in patients on antiplatelet and/or anticoagulant therapy: a position paper of National Association of Hospital Cardiologists (ANMCO) and the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO). Eur J Intern Med. 2021;85:1–13. doi:10.1016/j.ejim.2020.11.014

17. Kamada T., Satoh K., Itoh T., et al. Evidence- based clinical practice guidelines for peptic ulcer disease 2020. J Gastroenterol. 2021;56(4):303–322. doi:10.1007/s00535–021–01769–0

18. Huang K., Zhao X., Chen X., et al. Analysis of Digestive Endoscopic Results During COVID-19. J Transl Int Med. 2021;9(1):38–42. doi:10.2478/jtim-2021–0006

19. Gonzalez Gonzalez R., Jacob J., Miro O., et al. Incidence, Clinical Characteristics, Risk Factors, and Outcomes of Upper Gastrointestinal Bleeding in Patients With COVID-19: Results of the UMC-19-S12. J Clin Gastroenterol. 2022;56(1): e38-e46. doi:10.1097/MCG.0000000000001465

20. Iqbal U., Anwar H., Siddiqui H. U., et al. Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis. Clin Endosc. 2021;54(4):534–541. doi:10.5946/ce.2021.071

21. Vanella G., Capurso G., Burti C., et al. Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study. BMJ Open Gastroenterol. 2021;8(1): e000578. doi:10.1136/bmjgast-2020–000578

22. Patel P., Sengupta N. PPIs and Beyond: A Framework for Managing Anticoagulation-Related Gastrointestinal Bleeding in the Era of COVID-19. Dig Dis Sci. 2020;65(8):2181–2186. doi:10.1007/s10620–020–06408-x