Decline in acute upper gastrointestinal bleeding during COVID-19 pandemic after initiation of lockdown in Austria

Abstract

Background COVID-19 has spread rapidly around the world. The Austrian government implemented a lockdown on 16 March to contain further spread of the disease. We investigated the effects of lockdown on acute upper gastrointestinal (GI) bleeding in Austria.

Methods We contacted 98 Austrian hospitals performing emergency endoscopies. The hospitals were asked to report upper GI endoscopies performed for recent hematemesis, melena, or both, and exhibiting endoscopically visible signs of bleeding. The study period was from 3 weeks before (calendar Week 9) to 3 weeks after (Week 14) initiation of the lockdown.

Results 61 % of Austrian hospitals, and importantly all major state hospitals, responded. A total of 575 upper GI bleedings occurred during the 3 weeks before and 341 during the 3 weeks after initiation of lockdown (40.7 % reduction). There was a 54.6 % decline in nonvariceal bleeding events at Week 14 compared with Week 9 (89 vs. 196), whereas rates of variceal hemorrhage did not change (15 vs. 17).

Conclusions National lockdown resulted in a dramatic decrease in upper GI bleeding events in Austrian hospitals.

Publication History

Received: 18 April 2020

Accepted: 14 May 2020

Accepted Manuscript online:
14 May 2020

Article published online:
09 July 2020

• References

• 1 Zhu N, Zhang D, Wang W. et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382: 727-733
• 2 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507-513
• 3 Ng SC, Tilg H. COVID-19 and the gastrointestinal tract: more than meets the eye. Gut 2020;
• 4 Zhang Y, Xiao M, Zhang S. et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med 2020;
• 5 Pan A, Liu L, Wang C. et al. Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China. JAMA 2020;
• 6 Nussbaumer-Streit B, Mayr V, Dobrescu AI. et al. Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. Cochrane Database Syst Rev 2020; 4: CD013574
• 7 Tian H, Liu Y, Li Y. et al. An investigation of transmission control measures during the first 50 days of the COVID-19 epidemic in China. Science 2020;
• 8 Rossman H, Keshet A, Shilo S. et al. A framework for identifying regional outbreak and spread of COVID-19 from one-minute population-wide surveys. Nat Med 2020;
• 9 Metzler B, Siostrzonek P, Binder RK. et al. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J 2020; 41: 1852-1853
• 10 Thornton J. Covid-19: A&E visits in England fall by 25% in week after lockdown. BMJ 2020; 369: m1401
• 11 Lau JYW, Yu Y, Tang RSY. et al. Timing of endoscopy for acute upper gastrointestinal bleeding. N Engl J Med 2020; 382: 1299-1308
• 12 Bardou M, Quenot JP, Barkun A. Stress-related mucosal disease in the critically ill patient. Nat Rev Gastroenterol Hepatol 2015; 12: 98-107
• 13 Nardone G, Compare D. The psyche and gastric functions. Dig Dis 2014; 32: 206-212
• 14 Haukeland JW, Smastuen MC, Palsdatter PP. et al. Effect of gender on mortality and causes of death in cirrhotic patients with gastroesophageal varices. A retrospective study in Norway. PLoS One 2020; 15: e0230263
• 15 Chiu PWY, Ng SC, Inoue H. et al. Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements). Gut 2020;