الفهرس 
Aim of the studyOnly 14 pages are availabe for public view
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Abstract
Coronavirus disease 2019 (COVID-19) is a viral respiratory illness caused by a novel coronavirus (nCOV). The outbreak was first identified in Wuhan, China in December 2019.
However, the most common clinical features of COVID-19 include fever, cough, fatigue, and dyspnea; upper GI symptoms have been recognized. Additionally, many observational studies have reported increased risk of UGIB in hospitalized COVID-19 patients.
The aim of the work was to study the etiology, risk factors and outcomes of UGIB in COVID-19 infected Egyptian patients.
This cross-sectional study was applied to 400 COVID-19-infected Egyptian patients selected from inpatients and outpatient clinics of the Tropical Medicine and Emergency Medicine departments, at Menoufia university hospitals from July 2021 to July 2022. Patients were classified into two groups according to the development of UGIB: group I: COVID-19 infected patients with UGIB, who sub classified according to Blatchford Score (IA: mild (60 patients), IB: severe (140 patients)) and group II: COVID-19 infected patients without UGIB (200 patients).
All the included patients were subjected to the following: full history taking (such as history of DM & hypertension & chronic liver disease and anticoagulant use before admission), thorough clinical examination (general, local examination), and laboratory investigations including Complete blood count (CBC), Liver function tests (aspartate aminotransferase. (AST), alanine aminotransferase (ALT)), Prothrombin time (PT) & international normalized ratio (INR), kidney function tests (urea, creatinine), C-reactive protein (CRP), Lactate dehydrogenase (LDH), D dimer, s. ferritin, viral markers (HBs -Ag, HCV-Ab, and HIV-Ab) by
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ELISA, and PCR for COVID-19-Ag) and radiological investigations in the form of pelviabdominal ultrasound and CT chest. Patients with significant microcytic hypochromic anemia, occult blood test was done, EGD was done for positive cases
Pre-endoscopic assessment and resuscitation were performed. All patients with UGBI have been examined endoscopic till the second part of duodenum. Endoscopic findings have been reported and probable causes of UGIB were recorded and correlated with clinical presentations, laboratory investigations and outcomes with COVID-19 infection severity and outcomes.
Statistical analysis of the study revealed the following:
• No significant difference between studied groups regarding age (p value= .278) and sex distribution. (p value= .435)
• A statistically significant difference between the studied groups was reported regarding history of DM (p= 0.010) and highly statistically significant difference between the studied groups regarding history of CLD (p= <0.001)
• A highly statistically significant difference between the studied groups regarding complaint (p<0.001) as hematemesis and melena were significantly higher in group IA and group IB than group II
• A statistically significant difference between the studied groups regarding anticoagulant use (p: 0.004) and NSAIDs use (p =0.011)
• Our study revealed a statistically significant difference between the studied groups regarding O2 saturation, and respiratory rate (p<0.05) with highly statistically significant difference regarding ABP, temperature and pulse (=<0 .001) between the three studied groups.
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• A Statistically significant difference between the studied groups regarding COVID-19 findings in CT chest was seen (p=0.023).
• A highly statistically significant difference between the studied groups regarding need for oxygen therapy, ICU admission, assisted ventilation, status of patients on discharge, need for blood transfusion and cause of death (p<0.001). Moreover, there was statistically significant difference between the studied groups regarding length of ICU stay (p=0.016)
• Based on univariate and multivariate analysis: the use of anticoagulant & corticosteroids & NSAIDs, D dimer, length of stay in the hospital & ICU admission, and length of stay in the ICU were the most significant factors associated with COVID-19 &UGIB mortality
• Based on univariate and multivariate analysis Duration of symptoms, the use of (anticoagulant &Corticosteroids & NSAIDS), laboratory investigations as (CRP& D-dimer & ferritin & LDH &INR), Length of ICU stay, ICU admission and length of hospital stay were the most significant factors associated with COVID-19 mortality
• A highly statistically significant difference between the two groups with UGIB regarding the etiology of the bleeding, where esophageal & gastric varices were the most common causes in group IB and gastric &duodenal ulcers were the most common causes in group IA (p value<0.001).
• Most of the patients presenting with esophageal and\or Gastric varices had bad outcome (died) while most of the patients presenting with Gastric and\or duodenal ulcers improved with a highly statistically significant difference. (p value<0.001).