Under what conditions can coronavirus cause bleeding in the stomach?

In addition to lung problems, a person who gets sick with CORONAVIRUS may also experience gastrointestinal bleeding. The SARS-CoV-2 virus damages the epithelium of the stomach, rectum and duodenum, and treatment (especially with anticoagulants) exacerbates the situation.

DOCTOR of Medical Sciences, Professor of the Department of Surgery, HEAD of the Gastroenterological Center of Krasnodar Regional Hospital No. 2 Natalya Korochanskaya said that anticoagulants can also provoke thrombosis, so they are often used together with antiplatelet drugs.

- The use of antiplatelet therapy has shown benefit in patients with covid-19 . But we must not forget about the possible risk of bleeding of the mucous membrane of the gastrointestinal tract, the physician warned.

If the word “bleeding” doesn’t scare you enough, it’s worth saying that this is a serious complication of many serious diseases, which can even lead to death. And at the same time - one of the private side effects of the use of anticoagulants. According to statistics, such an undesirable phenomenon occurs in 160 out of 100 thousand adults a year, and leads to death in 10-14% of cases.

The cause of bleeding when taking the medication can be erosion and ulcers of both the stomach and duodenum, erosion of the esophagus, intestinal diverticulosis, angiodysplasia of the mucosa of the lower gastrointestinal tract, Dieulafoy's ulcer. The doctor's task in this case is to eliminate modifiable risk factors for bleeding. Korochanskaya claims that taking non-steroidal anti-inflammatory drugs (NSAIDs) can also cause bleeding in the gastrointestinal tract. Risk factors will be female gender, age over 60, a history of ulcer or gastrointestinal bleeding, long-term use of NSAIDs, coronary artery disease, H. Pylori, tobacco smoking, ALCOHOL abuse.

The professor emphasized that smoking, which in itself can provoke peptic ulcer of the stomach or duodenum, stands out especially in this list.

- The temperature of tobacco smoke in the mouth is about 50-60 degrees. From exposure to tobacco combustion products and high temperatures, the enamel is destroyed and turns yellow, and the salivary glands are irritated. Approximately 15 minutes after smoking, blood vessels spasm, and the acidity of gastric juice increases. Nicotine reduces pyloric sphincter pressure and allows duodenogastric reflux, which increases the risk of stomach ulcers. Cigarette smoking promotes apoptosis, that is, the programmed death of cells in the gastrointestinal mucosa, and disrupts the formation of blood vessels in the gastric mucosa, which blocks the process of cell renewal. In addition, tobacco smoke contains over 7,000 chemicals, of which at least 250 are known to be toxic and at least 69 are known to cause cancer.

Accordingly, along with drug therapy, it is recommended to completely stop smoking. When applying for medical care, you need to clarify the status of smoking and fix the answer. It is important to remember that there are people who do not smoke every day - such patients may believe that they do not have any addiction. In any case, with a positive status, it is advisable to counsel on the benefits of quitting smoking. If the patient quit within a year, he needs especially close attention to prevent a relapse. If the conversation about risks and negative consequences does not have the desired effect, it is possible to talk about the concept of harm reduction. It involves the transition to alternative sources of nicotine delivery. For example, electronic tobacco heating systems.

Korochanskaya claims that it is possible to reduce the risk of bleeding in the stomach associated with Helicobacter pylori and / or taking NSAIDs using a certain algorithm:

- Regardless of concomitant disease, determine the presence of H. Pylori. If the patient is taking non-steroidal anti-inflammatory drugs and a change is possible, administer an alternative (eg, ergotamine and triptans).

If NSAID replacement is not possible and H. pylori is not present, the doctor recommends proton pump inhibitors, which will reduce acidity and stabilize antibiotics in the stomach. Decreased acidity will put the infection into a vegetative state.

- H. pylori infection in patients on and without non-steroidal anti-inflammatory drugs increases the risk of developing peptic ulcers, which may lead to an increased bleeding rate. For patients taking non-steroidal anti-inflammatory and anticoagulants, eradication therapy can be applied to reduce the risk of developing peptic ulcer, says the professor.

| Prepared based on PMI materials, photo from open Internet sources.