Original Article
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Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis
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Umair Iqbal
, Hafsa Anwar
, Hafiz Umair Siddiqui
, Muhammad Ali Khan
, Faisal Kamal
, Bradley D. Confer
, Harshit S. Khara
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Clin Endosc 2021;54(4):534-541. Published online June 25, 2021
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DOI: https://doi.org/10.5946/ce.2021.071
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Abstract
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- Background
/Aims: More than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB).
Methods
A systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB.
Results
Our search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%–9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%–18.4%).
Conclusions
The majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful.
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Citations
Citations to this article as recorded by

- Prognostic model of the risk of gastroduodenal bleeding in COVID-19 patients with morphometric assessment of factors contributing to vascular wall remodeling
K. V. Medvedev, V. A. Zinserling, M. A. Protchenkov, A. L. Ivanov, I. A. Solovyov, N. Yu. Kohanenko, R. G. Avanesyan, K. E. Borta, N. Yu. Semenova
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Erin Sanzone, Katherine Gheysens, Krystal Hunter, Adib Chaaya, Sangita Phadtare, Tatsuya Toyokawa
Gastroenterology Research and Practice.2025;[Epub] CrossRef - Increased Overall Mortality in Patients Admitted for Gastrointestinal Bleeding and COVID-19 Infection Compared to No COVID-19 Infection: A Systematic Review and Meta-Analysis
Sergiu Marian Cazacu, Adina Turcu-Stiolica, Cristina Maria Marginean, Ion Rogoveanu
Gastroenterology Insights.2025; 16(3): 20. CrossRef - Prevalence and outcomes of upper gastrointestinal bleeding in COVID‐19: A systematic review and meta‐analysis
Sawai Singh Rathore, Zario Shai Wint, Aman Goyal, Bijay Mukesh Jeswani, Ameer Mustafa Farrukh, María Alejandra Nieto‐Salazar, Thanmai Reddy Thugu, Snigdha Erva, Raafay Mehmood, Adriana Carolina Toro‐velandia, Hamam Aneis, Sunny Ratnani, Ibrahim Marouf Yas
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Mohammad Aldiabat, Wesam Aleyadeh, Taimur Muzammil, Kemi Adewuyi, Majd Alahmad, Ahmad Jabri, Laith Alhuneafat, Yassine Kilani, Saqr Alsakarneh, Mohammad Bilal
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Waqas Rasheed, Gnanashree Dharmarpandi, Ola Al-Jobory, Anass Dweik, Muhammad Anil, Sameer Islam
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V. D. Anosov, S. A. Domrachev, S. V. Ovchinnikov, N. O. Solovyov
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Hassan Ashktorab, Tiziano Russo, Gholamreza Oskrochi, Giovanni Latella, Sara Massironi, Martina Luca, Lakshmi G. Chirumamilla, Adeyinka O. Laiyemo, Hassan Brim
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Case Reports
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Gastrointestinal Bleeding and Endoscopic Outcomes in Patients with SARS-CoV-2
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Faruq Pradhan
, Yasmin Alishahi
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Clin Endosc 2021;54(3):428-431. Published online March 3, 2021
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DOI: https://doi.org/10.5946/ce.2020.244
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Abstract
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- Over the past year, the novel coronavirus has been a topic of significant research. Multiple gastroenterological symptoms have been associated with this infection, in addition to the well-established pulmonary presentations. Gastrointestinal bleeding can be a complication of infection by severe acute respiratory syndrome coronavirus-2, which can be exacerbated by the anticoagulants used to treat its thrombotic sequelae. We describe the clinical cases of four patients infected with the novel coronavirus, with significant upper gastrointestinal bleeding requiring endoscopic visualization, along with their clinical outcomes.
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Citations
Citations to this article as recorded by

- Increased Overall Mortality in Patients Admitted for Gastrointestinal Bleeding and COVID-19 Infection Compared to No COVID-19 Infection: A Systematic Review and Meta-Analysis
Sergiu Marian Cazacu, Adina Turcu-Stiolica, Cristina Maria Marginean, Ion Rogoveanu
Gastroenterology Insights.2025; 16(3): 20. CrossRef - Prevalence and outcomes of upper gastrointestinal bleeding in COVID‐19: A systematic review and meta‐analysis
Sawai Singh Rathore, Zario Shai Wint, Aman Goyal, Bijay Mukesh Jeswani, Ameer Mustafa Farrukh, María Alejandra Nieto‐Salazar, Thanmai Reddy Thugu, Snigdha Erva, Raafay Mehmood, Adriana Carolina Toro‐velandia, Hamam Aneis, Sunny Ratnani, Ibrahim Marouf Yas
Reviews in Medical Virology.2024;[Epub] CrossRef - Gastrointestinal Bleeding in COVID-19 Infected Patients, and Management Outcomes
Amnah Al Hanaei, Fatima AlKindi, Aysha Alkhemeiri, Satish Nair
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Mitchell S. Cappell, David M. Friedel
Gastroenterology Clinics of North America.2023; 52(1): 77. CrossRef - Endoscopic findings are not different in patients with upper gastrointestinal bleeding with COVID-19
Fatma Ebru AKIN, Öykü TAYFUR YÜREKLİ, Mustafa TAHTACI, Osman ERSOY
Akademik Gastroenteroloji Dergisi.2023; 22(1): 20. CrossRef
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Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report
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Epifanio Silvino do Monte Junior, Marcos Eduardo Lera dos Santos, Igor Braga Ribeiro, Gustavo de Oliveira Luz, Elisa Ryoka Baba, Bruno Salomão Hirsch, Mateus Pereira Funari, Eduardo Guimarães Hourneaux de Moura
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Clin Endosc 2020;53(6):746-749. Published online November 19, 2020
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DOI: https://doi.org/10.5946/ce.2020.180
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Abstract
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- The novel coronavirus disease (COVID-19) quickly spread to all continents. However, data regarding all the signs and symptoms of COVID-19 are insufficient. Patients with COVID-19 might present higher susceptibility to fungal coinfections. Mucormycosis is a rare and often life-threatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. This is the first case report of mucormycosis in a COVID-19 patient. An 86-year-old male patient was admitted to the emergency room with acute diarrhea, cough, dyspnea, and fever from 5 days prior. Blood tests revealed a hemoglobin level of 14.3 mg/dL. Five days following the admission, the patient presented with melena and a hemoglobin level of 5.6 mg/dL. A transfusion of three units of red blood cells was required. Esophagogastroduodenoscopy revealed two giant gastric ulcers with necrotic debris and a deep hemorrhagic base without active bleeding. Furthermore, biopsies confirmed mucormycosis. Despite intensive care, the patient died 36 hours after the esophagogastroduodenoscopy.
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Focused Review Series: Endoscopic Disinfection in the Era of MERS
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Role of Clinical Endoscopy in Emphasizing Endoscope Disinfection
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Ji Kon Ryu, Eun Young Kim, Kwang An Kwon, Il Ju Choi, Ki Baik Hahm
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Clin Endosc 2015;48(5):351-355. Published online September 30, 2015
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DOI: https://doi.org/10.5946/ce.2015.48.5.351
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Abstract
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Based on the unexpected Middle East respiratory syndrome (MERS) outbreak in Korea, it was established that the virus can spread easily, MERS exposure in hospitals carries an extreme risk for infection as well as mortality, and the sharing of information was essential for infection control. Although the incidence of exogenous infections related to contaminated endoscopes is very low, the majority of published outbreaks have been caused by various shortcomings in reprocessing procedures, including insufficient training or awareness. Ever since the inauguration of "Clinical Endoscopy" as an English-language journal of the Korean Society of Gastrointestinal Endoscopy in 2011, it has published several articles on disinfection of the endoscope and its accessories. Many Science Citation Index journals have also emphasized high-level disinfection of the gastrointestinal endoscope. Many papers have been produced specifically, since the outbreak of carbapenem-resistant Enterobacteriaceae in 2013. The recent review papers concluded that quality control is the most important issue among all the aspects of procedural care, including the efficiency of the gastrointestinal endoscopy unit and reprocessing room. Thorough reprocessing of endoscopes using high-level disinfection and sterilization methods may be essential for reducing the risk of infection.
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