Evidence map›Paper›PMID 33519132›Full record

ArticleJournal of clinical and experimental hepatology

Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding.

Shalimar, Manas Vaishnav, Anshuman Elhence, Ramesh Kumar, Srikant Mohta, Chandan Palle, Peeyush Kumar, Mukesh Ranjan, Tanmay Vajpai, Shubham Prasad and 19 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical and experimental hepatology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 2 pooled it
3.0field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 27 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
  8. Gastrointestinal Bleeding in COVID-19-Infected Patients.Gastroenterology clinics of North America · 2023
    Review
  9. Article
  10. Review
  11. Article
  12. Article
  13. Coronavirus Disease-2019 (COVID-19) and the Liver.Journal of clinical and translational hepatology · 2021
    Review
  14. Article
  15. Article
  16. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

29 authors at 1 institution in 1 country.

ShalimarDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Manas VaishnavDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Anshuman ElhenceDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Ramesh KumarDepartment of Gastroenterology, All India Institute of Medical Sciences, Patna, India.
Srikant MohtaDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Chandan PalleDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Peeyush KumarDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Mukesh RanjanDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Tanmay VajpaiDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Shubham PrasadDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Jatin YegurlaDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Anugrah DhooriaDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Vikas BanyalDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Samagra AgarwalDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Rajat BansalDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Sulagna BhattacharjeeDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Richa AggarwalDepartment of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi.
Kapil D SoniDepartment of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi.
Swetha RudravaramDepartment of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi.
Ashutosh K SinghDepartment of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi.
Irfan AltafDepartment of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi.
Avinash ChoudekarDepartment of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Soumya J MahapatraDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Deepak GunjanDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Saurabh KediaDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Govind MakhariaDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Anjan TrikhaDepartment of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi.
Pramod GargDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Anoop SarayaDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
All India Institute of Medical Sciences · IN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND/

objectiveThere is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with Coronavirus disease -2019 (COVID-19) amid concerns about the risk of transmission during endoscopic procedures. We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19.

methodsIn this retrospective analysis, 24 of 1342 (1.8%) patients with COVID-19, presenting with GI bleeding from 22nd April to 22nd July 2020, were included.

resultsThe mean age of patients was 45.8 ± 12.7 years; 17 (70.8%) were males; upper GI (UGI) bleeding: lower GI (LGI) 23:1. Twenty-two (91.6%) patients had evidence of cirrhosis- 21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors-somatostatin in 17 (73.9%) and terlipressin in 4 (17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells (PRBCs), fresh frozen plasma (FFPs) and platelets were transfused in 14 (60.9%), 3 (13.0%) and 3 (13.0%), respectively. The median PRBCs transfused was 1 (0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three (12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay.

conclusionConservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy. The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patient's condition, response to treatment, resources and the risks involved, on a case to case basis.

Indexed as

AD, Acute decompensationAIH, Autoimmune hepatitisAIMS65, Albumin, international normalized ratio, mental status, systolic blood pressure, age > 65CarvedilolCLD, Chronic liver diseaseCOVID-19, Coronavirus disease −2019CRS, Clinical Rockall ScoreEndoscopyFFP, Fresh frozen plasmaGAVE, Gastric antral vascular ectasiaGBS, Glasgow-Blatchford bleeding scoreGI, GastrointestinalHE, Hepatic encephalopathyHVPG, Hepatic venous pressure gradientINR, International normalized ratioLGI, Lower gastrointestinalLiver transplantmGBS, Modified Glasgow-Blatchford bleeding scoreMOHFW, Ministry of Health and Family WelfareNSAIDs, Non-steroidal anti-inflammatory drugsPPE, Personal protective equipmentPRBC, Packed red blood cellsPrognosisProton pump inhibitorsRR, Respiratory rateRT-PCR, Reverse transcriptase polymerase chain reactionSARS-CoV2, Severe acute respiratory syndrome Coronavirus 2UGI, Upper gastrointestinalVariceal bleeding

Identifiers

PMID33519132
PMCPMC7833290
OpenAlexW3094731539

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.