Upper gastrointestinal bleeding (UGIB) in COVID-19 presents challenges in patient management. Existing studies lack comprehensive review due to varied designs, samples, and demographics. A meta-analysis can provide valuable insights into the incidence, features, and outcomes of UGIB in COVID-19. A comprehensive literature search was carried out using several databases. We considered all appropriate observational studies from all over the world. Mantel-Haenszel odds ratios and associated 95% confidence intervals (CIs) were produced to report the overall effect size using random effect models. Besides, Random effects models were used to calculate the overall pooled prevalence. Funnel plots, Egger regression tests, and Begg-Mazumdar's rank correlation test were used to appraise publication bias. Data from 21 articles consisting of 26,933 COVID-19 patients were considered. The pooled estimate of UGIB prevalence in patients admitted with COVID-19 across studies was 2.10% (95% CI, 1.23-3.13). Similarly, the overall pooled estimate for severity, mortality, and rebleeding in COVID-19 patients with UGIB was 55% (95% CI, 37.01-72.68), 29% (95% CI, 19.26-40.20) and 12.7% (95% CI, 7.88-18.42) respectively. Further, UGIB in COVID-19 patients was associated with increased odds of severity (OR = 3.52, 95% CI 1.80-6.88, P = 0.001) and mortality (OR = 2.16, 95% CI 1.33-3.51, P = 0.002) compared with patients without UGIB. No significant publication bias was evident in the meta-analysis. The results of our study indicate that UGIB in individuals with COVID-19 is linked to negative outcomes such as severe illness, higher mortality rates, and an increased risk of re-bleeding. These findings highlight the significance of identifying UGIB as a significant complication in COVID-19 cases and emphasise the importance of timely clinical assessment and proper treatment.

1st Faculty of Medicine Charles University Prague Czech Republic

All American Institute of Medical Sciences Black River Jamaica

Department of Internal Medicine Seth GS Medical College and KEM Hospital Mumbai India

Department of Internal Medicine UPMC Mckeesport Pennsylvania USA

Dr Sampurnanand Medical College Jodhpur Rajasthan India

GCS Medical College Hospital and Research Centre Ahmedabad India

Juan N Corpas University Bogotá D C Colombia

Larkin Community Hospital Miami Florida USA

MNR Medical College and Hospital Sangareddy India

Saint James School of Medicine The Quarter Anguilla

Sri Padmavathi Medical College for Women Tirupathi Andhra Pradesh India

University of Galway School of Medicine Galway Ireland

University of Sharjah Sharjah United Arab Emirates

Zobrazit více v PubMed

Singh R, Rathore SS, Khan H, et al. Mortality and severity in COVID-19 patients on ACEIs and ARBs-A systematic review, meta-analysis, and meta-regression analysis. Front Med. 2022;8:703661. PMID: 35083229; PMCID: PMC8784609. https://doi.org/10.3389/fmed.2021.703661

Iqbal U, Anwar H, Siddiqui HU, et al. Acute gastrointestinal bleeding in COVID-19 patients: a systematic review and meta-analysis. Clin Endosc. 2021;54(4):534-541. Epub 2021 Jun 25. PMID: 34176255; PMCID: PMC8357590. https://doi.org/10.5946/ce.2021.071

Sha A, Liu Y, Zhao X. SARS-CoV-2 and gastrointestinal diseases. Front Microbiol. 2023;14:1177741. PMID: 37323898; PMCID: PMC10267706. https://doi.org/10.3389/fmicb.2023.1177741

Ye L, Yang Z, Liu J, Liao L, Wang F. Digestive system manifestations and clinical significance of coronavirus disease 2019: a systematic literature review. J Gastroenterol Hepatol. 2021;36(6):1414-1422. Epub 2020 Dec 22. PMID: 33150978. https://doi.org/10.1111/jgh.15323

Rasheed W, Dharmarpandi G, Al-Jobory O, Dweik A, Anil M, Islam S. Increasing inpatient mortality of nonvariceal upper gastrointestinal bleeding during the COVID-19 pandemic: a nationwide retrospective cohort study. SAVE Proc. 2023;36(3):286-291. PMID: 37091770; PMCID: PMC10120561. https://doi.org/10.1080/08998280.2023.2177490

Prasoppokakorn T, Kullavanijaya P, Pittayanon R. Risk factors of active upper gastrointestinal bleeding in patients with COVID-19 infection and the effectiveness of PPI prophylaxis. BMC Gastroenterol. 2022;22(1):465. PMID: 36397007; PMCID: PMC9669529. https://doi.org/10.1186/s12876-022-02568-4

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339(jul21 1):b2535. Published 2009 Jul 21. https://doi.org/10.1136/bmj.b2535

Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses; 2013. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490. https://doi.org/10.1136/bmj.328.7454.1490

Castellini G, Bruschettini M, Gianola S, Gluud C, Moja L. Assessing imprecision in Cochrane systematic reviews: a comparison of GRADE and trial sequential analysis. Syst Rev. 2018;7(1):110. Published 2018 Jul 28. https://doi.org/10.1186/s13643-018-0770-1

Abulawi A, Al-Tarbsheh A, Leamon A, Feustel P, Chopra A, Batool A. Clinical characteristics of hospitalized COVID-19 patients who have gastrointestinal bleeds requiring intervention: a case-control study. Cureus. 2022;14(7):e26538. PMID: 35936188; PMCID: PMC9345793. https://doi.org/10.7759/cureus.26538

Akin FE, Tayfur Yürekli̇ Ö, Tahtaci M, Ersoy O. Endoscopic findings are not different in patients with upper gastrointestinal bleeding with COVID-19. Akademik Gastroenteroloji Dergisi. 2023;22(1):20-28. https://doi.org/10.17941/agd.1275659

Alakuş Ü, Kara U, Taşçı C, Eryılmaz M. Upper gastrointestinal system bleedings in COVID-19 patients: risk factors and management/a retrospective cohort study. Ulus Travma Acil Cerrahi Derg. 2022;28(6):762-768. English. PMID: 35652869. https://doi.org/10.14744/tjtes.2021.30513

Cavaliere K, Levine C, Wander P, Sejpal DV, Trindade AJ. Management of upper GI bleeding in patients with COVID-19 pneumonia. Gastrointest Endosc. 2020;92(2):454-455. Epub 2020 Apr 20. PMID: 32325065; PMCID: PMC7169931. https://doi.org/10.1016/j.gie.2020.04.028

Cazacu SM, Burtea DE, Iovănescu VF, et al. Outcomes in patients admitted for upper gastrointestinal bleeding and COVID-19 infection: a study of two years of the pandemic. Life (Basel). 2023;13(4):890. PMCID: PMC10146262. PMID: 37109419. https://doi.org/10.3390/life13040890

Dunne P, Livie V, McGowan A, et al. Increasing the low-risk threshold for patients with upper gastrointestinal bleeding during the COVID-19 pandemic: a prospective, multicentre feasibility study. Frontline Gastroenterol. 2021;13(4):303-308. PMID: 35712356; PMCID: PMC8390142. https://doi.org/10.1136/flgastro-2021-101851

González González R, Jacob J, Ò M, et al. Spanish investigators on emergency situations TeAm (SIESTA) network. 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. PMID: 33252555. https://doi.org/10.1097/MCG.0000000000001465

Eltayeb S, Aljaghber H, Al Assaf O, Al Hawai A, Banama M. A case series on upper GI bleeding among patients admitted with COVID-19 infection. J Health Inform Dev Count. 2022;16(2). https://www.jhidc.org/index.php/jhidc/article/view/373

Iqbal U, Patel PD, Pluskota CA, Berger AL, Khara HS, Confer BD. Outcomes of acute gastrointestinal bleeding in patients with COVID-19: a case-control study. Gastroenterol Res. 2022;15(1):13-18. Epub 2022 Jan 10. PMID: 35369679; PMCID: PMC8913019. https://doi.org/10.14740/gr1483

Ierardi AM, Coppola A, Tortora S, et al. Gastrointestinal bleeding in patients with SARS-CoV-2 infection managed by interventional radiology. J Clin Med. 2021;10(20):4758. PMID: 34682879; PMCID: PMC8541615. https://doi.org/10.3390/jcm10204758

Luu MN, Dang TP, Vo MH, Quach DT. Prevalence, causes, medical interventions, and mortality outcome of acute gastrointestinal bleeding among COVID-19 inpatients. Curr Med Res Opin. 2023;39(5):731-737. Epub 2023 Apr 20. PMID: 37026739. https://doi.org/10.1080/03007995.2023.2201097

Martin TA, Wan DW, Hajifathalian K, et al. Gastrointestinal bleeding in patients with coronavirus disease 2019: a matched case-control study. Am J Gastroenterol. 2020;115(10):1609-1616. PMID: 32796176; PMCID: PMC7446989. https://doi.org/10.14309/ajg.0000000000000805

Mauro A, De Grazia F, Lenti MV, et al. Upper gastrointestinal bleeding in COVID-19 inpatients: incidence and management in a multicenter experience from Northern Italy. Clin Res Hepatol Gastroenterol. 2021;45(3):101521. Epub 2020 Aug 14. PMID: 32888875; PMCID: PMC7427596. https://doi.org/10.1016/j.clinre.2020.07.025

Melazzini F, Lenti MV, Mauro A, De Grazia F, Di Sabatino A. Peptic ulcer disease as a common cause of bleeding in patients with coronavirus disease 2019. Am J Gastroenterol. 2020;115(7):1139-1140. PMID: 32618672; PMCID: PMC7273934. https://doi.org/10.14309/ajg.0000000000000710

Neuberger M, Jungbluth A, Irlbeck M, et al. Duodenal tropism of SARS-CoV-2 and clinical findings in critically ill COVID-19 patients. Infection. 2022;50(5):1111-1120. Epub 2022 Feb 18. PMID: 35182354; PMCID: PMC8857399. https://doi.org/10.1007/s15010-022-01769-z

Pradhan F, Alishahi Y. Gastrointestinal bleeding and endoscopic outcomes in patients with SARS-CoV-2. Clin Endosc. 2021;54(3):428-431. Epub 2021 Mar 3. PMID: 33652519; PMCID: PMC8182236. https://doi.org/10.5946/ce.2020.244

Shalimar VM, Elhence A, Kumar R, et al. Outcome of conservative therapy in coronavirus disease-2019 patients presenting with gastrointestinal bleeding. J Clin Exp Hepatol. 2021;11(3):327-333. Epub 2020 Oct 3. PMID: 33519132; PMCID: PMC7833290. https://doi.org/10.1016/j.jceh.2020.09.007

Tavabie OD, Clough JN, Blackwell J, et al. Reduced survival after upper gastrointestinal bleed endoscopy in the COVID-19 era is a secondary effect of the response to the global pandemic: a retrospective cohort study. Frontline Gastroenterol. 2020;12(4):279-287. PMID: 34249312; PMCID: PMC8231434. https://doi.org/10.1136/flgastro-2020-101592

Zellmer S, Hanses F, Muzalyova A, et al. Gastrointestinal bleeding and endoscopic findings in critically and non-critically ill patients with corona virus disease 2019 (COVID-19): results from Lean European Open Survey on SARS-CoV-2 (LEOSS) and COKA registries. United Eur Gastroenterol J. 2021;9(9):1081-1090. Epub 2021 Oct 15. PMID: 34655180; PMCID: PMC8598966. https://doi.org/10.1002/ueg2.12165

Rosevics L, Fossati BS, Teixeira S, Bem RS, Souza RCA. Covid-19 and digestive endoscopy: emergency endoscopic procedures and risk factors for upper gastrointestinal bleeding. Arq Gastroenterol. 2021;58(3):337-343. https://doi.org/10.1590/s0004-2803.202100000-57

Aslan AT, Şimşek H. Clinical features and pathophysiological mechanisms of COVID-19-associated gastrointestinal manifestations. Euroasian J Hepatogastroenterol. 2021;11(2):81-86. PMID: 34786361; PMCID: PMC8566155. https://doi.org/10.5005/jp-journals-10018-1347

Ghazanfar H, Kandhi S, Shin D, et al. Impact of COVID-19 on the gastrointestinal tract: a clinical review. Cureus. 2022;14(3):e23333. PMID: 35464519; PMCID: PMC9017282. https://doi.org/10.7759/cureus.23333

Abdeen A, Abdelkader A, Elgazzar D, et al. Coenzyme Q10 supplementation mitigates piroxicam-induced oxidative injury and apoptotic pathways in the stomach, liver, and kidney. Biomed Pharmacother. 2020;130:110627. Epub 2020 Aug 28. PMID: 34321156; PMCID: PMC7453214. https://doi.org/10.1016/j.biopha.2020.110627

Palazzuoli A, Giustozzi M, Ruocco G, Tramonte F, Gronda E, Agnelli G. Thromboembolic complications in Covid-19: from clinical scenario to laboratory evidence. Life (Basel). 2021;11(5):395. PMCID: PMC8145351. PMID: 33925334. https://doi.org/10.3390/life11050395

Wagner DD, Heger LA. Thromboinflammation: from atherosclerosis to COVID-19. Arterioscler Thromb Vasc Biol. 2022;42(9):1103-1112. Epub 2022 Jul 8. PMID: 35861953; PMCID: PMC9420806. https://doi.org/10.1161/ATVBAHA.122.317162

Rehana RW, Fahad H, Sadiq O, Schairer J. Outcomes of gastrointestinal bleeding during the COVID-19 pandemic. Gastro Hep Adv. 2022;1(3):342-343. Epub 2022 Feb 11. PMID: 35174367; PMCID: PMC8831120. https://doi.org/10.1016/j.gastha.2022.02.006

Kreidieh F, Temraz S. Anticoagulation for COVID-19 patients: a bird's-eye view. Clin Appl Thromb Hemost. 2021;27:10760296211039288. https://doi.org/10.1177/10760296211039288

Chandra A, Chakraborty U, Ghosh S, Dasgupta S. Anticoagulation in COVID-19: current concepts and controversies. Postgrad Med J. 2022;98(1159):395-402. https://doi.org/10.1136/postgradmedj-2021-139923

Halaby R, Cuker A, Yui J, et al. Bleeding risk by intensity of anticoagulation in critically ill patients with COVID-19: a retrospective cohort study. J Thromb Haemost. 2021;19(6):1533-1545. https://doi.org/10.1111/jth.15310

Cappell MS, Friedel DM. Gastrointestinal bleeding in COVID-19-infected patients. Gastroenterol Clin North Am. 2023;52(1):77-102. Epub 2022 Nov 1. PMID: 36813432; PMCID: PMC9622379. https://doi.org/10.1016/j.gtc.2022.10.004

Ksiądzyna D, Szeląg A. The proton pump inhibitors use and COVID-19 from prior to vaccination perspective: a review. Dig Dis. 2023;41(3):513-521. Epub 2022 Oct 18. PMID: 36257287. https://doi.org/10.1159/000527501

Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila FI, Soares-Weiser K, Uribe M. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010;2010(9):CD002907. PMID: 20824832; PMCID: PMC7138054. https://doi.org/10.1002/14651858.CD002907.pub2