COVID-associated pathomorphological changes in the gastric mucosa during gastrointestinal bleeding
https://doi.org/10.5922/2223-2427-2025-10-1-2
Abstract
Aim. Analysis of morphological changes in the mucous membrane of the gastrointestinal tract that developed against the background of COVID-19-associated pneumonia, accompanied by bleeding.
Methods. The study included 72 cases of erosive and ulcerative gastroduodenal bleeding with complicated Covid-pneumonia. The patients were treated at the University Clinical Hospital No. 4 of Sechenov Moscow State Medical University (Sechenov University) from April 2020 to March 2022.
Results. Morphological examination of biopsies from the gastrointestinal tract has provided irrefutable evidence of both direct and indirect effects of the SARS-CoV2 virus on cells of the gastrointestinal mucosa.
Conclusion. The gastric mucosa in COVID-19 patients is exposed to the virus, which leads to erosive and ulcerative changes in it, leading to bleeding. This is simultaneously facilitated by anticoagulant and anti-inflammatory therapy given to such patients. These complications must be anticipated and prevented in a timely manner.
About the Authors
T. V. KhorobrykhRussian Federation
Tatiana V. Khorobrykh – Professor of the Russian Academy of Sciences, Head of the Department of the Faculty Surgery Clinic №2 named after G.I. Lukomsky
Bolshaya Pirogovskaya Str., 2, B. 4, Moscow, 119991;
Dovatora Str., 15, B. 2, Moscow, 119048
D. D. Protsenko
Russian Federation
Dmitry D. Protsenko – Associate Professor of the Institute of Clinical Morphology and Digital Pathology
Bolshaya Pirogovskaya Str., 2, B. 4, Moscow, 119991
K. A. Kammaev
Russian Federation
Kerim A. Kammaev – Endoscopist
Bolshaya Pirogovskaya Str., 2, B. 4, Moscow, 119991;
Dovatora Str., 15, B. 2, Moscow, 119048
A. A. Petrovskaya
Russian Federation
Alexandra A. Petrovskaya – Associate Professor of the Department of Faculty Surgery №2 named after I.G. Lukomsky
Bolshaya Pirogovskaya Str., 2, B. 4, Moscow, 119991;
Dovatora Str., 15, B. 2, Moscow, 119048
M. Yu. Krylova
Russian Federation
Marina Y. Krylova - Senior laboratory assistant at the Department of Faculty Surgery №2 named after I.G. Lukomsky
Bolshaya Pirogovskaya Str., 2, B. 4, Moscow, 119991
A. M. Sentyurina
Russian Federation
Arina M. Sentyurina – student of N.V.Sklifosovsky Institute of Clinical Medicine
Bolshaya Pirogovskaya Str., 2, B. 4, Moscow, 119991
A. K. Saakyan
Russian Federation
Asmik K. Saakyan – student of N.V.Sklifosovsky Institute of Clinical Medicine
Bolshaya Pirogovskaya Str., 2, B. 4, Moscow, 119991
References
1. Bortolotti D, Simioni C, Neri LM, Rizzo R, Semprini CM, Occhionorelli S, Laface I, Sanz JM, Schiuma G, Rizzo S, Varano G, Beltrami S, Gentili V, Gafà R, Passaro A. Relevance of VEGF and CD147 in different SARS-CoV-2 positive digestive tracts characterized by thrombotic damage. FASEB J. 2021 Dec;35(12):e21969. https://doi.org/10.1096/fj.202100821RRR
2. Rizzo R, Neri LM, Simioni C, Bortolotti D, Occhionorelli S, Zauli G, Secchiero P, Semprini CM, Laface I, Sanz JM, Lanza G, Gafà R, Passaro A. SARS-CoV-2 nucleocapsid protein and ultrastructural modifications in small bowel of a 4-week-negative COVID-19 patient. Clin Microbiol Infect. 2021 Jun;27(6):936-937. https://doi.org/10.1016/j.cmi.2021.01.012
3. Galán M, Jiménez-Altayó F. Small Resistance Artery Disease and ACE2 in Hypertension: A New Paradigm in the Context of COVID-19. Front Cardiovasc Med. 2020 Oct 30;7:588692. https://doi.org/10.3389/fcvm.2020.588692
4. Yan T, Xiao R, Lin G. Angiotensin-converting enzyme 2 in severe acute respiratory syndrome coronavirus and SARS-CoV-2: A double-edged sword? FASEB J. 2020 May;34(5):6017-6026. https://doi.org/10.1096/fj.202000782
5. Lobanova O.A., Trusova D.S., Rudenko E.E., Protsenko D.D., Kogan E.A. Pathomorphology of a new coronavirus infection COVID-19. Siberian Journal of Clinical and Experimental Medicine. 2020;35(3):47-52. (In Russ.) https://doi.org/10.29001/2073-8552-2020-35-3-47-52
6. Kogan E. A., Berezovsky Yu. S., Protsenko D. D., Bagdasaryan T. R., Gretsov E. M., Demura S. A., Demyashkin G. A., Kalinin D. V., Kukleva A. D., Kurilina E. V., Nekrasova T. P., Paramonova N. B., Ponomarev A. B., Raden skaLopovok S. G., Semyonova L. A., Tertychny A. S. Pathological Anatomy of Infection Caused by SARS-CoV-2. Russian Journal of Forensic Medicine. 2020;6(2):8– 30. (In Russ.). https://doi.org/10.19048/2411-8729-2020-6-2-8-3
7. Peiris S, Mesa H, Aysola A, Manivel J, Toledo J, Borges-Sa M, Aldighieri S, Reveiz L. Pathological findings in organs and tissues of patients with COVID-19: A systematic review. PLoS One. 2021 Apr 28;16(4):e0250708. https://doi.org/10.1371/journal.pone.0250708
8. Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in Hospitalized Patients With COVID-19 in a New York City Health System. JAMA. 2020 Aug 25;324(8):799-801. https://doi.org/10.1001/jama.2020.13372
9. Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V, Pesenti A, Peyvandi F, Tripodi A. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost. 2020 Jul;18(7):1738-1742. https://doi.org/10.1111/jth.14850
10. Ministry of Health of the Russian Federation. Temporary methodological recommendations. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Version 18 (26 October, 2023), 2023, 258 p. (In Russ.)
11. Porfidia A, Valeriani E, Pola R, Porreca E, Rutjes AWS, Di Nisio M. Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis. Thromb Res. 2020 Dec;196:67-74. https://doi.org/10.1016/j.thromres.2020.08.020
12. Chen J, Hang Y. Characteristics, risk factors and outcomes of gastrointestinal hemorrhage in COVID-19 patients: A meta-analysis. Pak J Med Sci. 2021 Sep-Oct;37(5):1524-1531. https://10.12669/pjms.37.5.4351
13. Carfora V, Spiniello G, Ricciolino R, Di Mauro M, Migliaccio MG, Mottola FF, Verde N, Coppola N; Vanvitelli COVID-19 group. Anticoagulant treatment in COVID-19: a narrative review. J Thromb Thrombolysis. 2021 Apr;51(3):642-648. https://10.1007/s11239-020-02242-0
14. Chow JH, Khanna AK, Kethireddy S, Yamane D, Levine A, Jackson AM, McCurdy MT, Tabatabai A, Kumar G, Park P, Benjenk I, Menaker J, Ahmed N, Glidewell E, Presutto E, Cain S, Haridasa N, Field W, Fowler JG, Trinh D, Johnson KN, Kaur A, Lee A, Sebastian K, Ulrich A, Peña S, Carpenter R, Sudhakar S, Uppal P, Fedeles BT, Sachs A, Dahbour L, Teeter W, Tanaka K, Galvagno SM, Herr DL, Scalea TM, Mazzeffi MA. Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease 2019. Anesth Analg. 2021 Apr 1;132(4):930-941. https://10.1213/ANE.0000000000005292
15. Giollo A, Adami G, Gatti D, Idolazzi L, Rossini M. Coronavirus disease 19 (Covid-19) and nonsteroidal anti-inflammatory drugs (NSAID). Ann Rheum Dis. 2021 Feb;80(2):e12. https://10.1136/annrheumdis-2020-217598
16. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, Li T, Chen Q. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020 Feb 24;12(1):8. https://doi.org/10.1038/s41368-020-0074-x
17. Bradley BT, Maioli H, Johnston R, Chaudhry I, Fink SL, Xu H, Najafian B, Deutsch G, Lacy JM, Williams T, Yarid N, Marshall DA. Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series. Lancet. 2020 Aug 1;396(10247):320-332. https://doi.org/10.1016/S0140-6736(20)31305-2
18. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020 Apr 7;323(13):1239-1242. https://doi.org/10.1001/jama.2020.2648
19. Yu F, Yan L, Wang N, Yang S, Wang L, Tang Y, Gao G, Wang S, Ma C, Xie R, Wang F, Tan C, Zhu L, Guo Y, Zhang F. Quantitative Detection and Viral Load Analysis of SARS-CoV-2 in Infected Patients. Clin Infect Dis. 2020 Jul 28;71(15):793-798. https://doi.org/10.1093/cid/ciaa345
20. [Pavlikova E.P., Agapov M.A., Malakhov P.S., Galliamov E.A., Esakov Yu.S., Markaryan D.R., Kakotkin V.V., Kubyshkin V.A. Mediastinal Emphysema as a Specific Complication of COVID-19 (Case Report). General Reanimatology. 2021;17(2):4-15. https://doi.org/10.15360/1813-9779-2021-2-4-15
21. Galanopoulos M, Gkeros F, Doukatas A, Karianakis G, Pontas C, Tsoukalas N, Viazis N, Liatsos C, Mantzaris GJ. COVID-19 pandemic: Pathophysiology and manifestations from the gastrointestinal tract. World J Gastroenterol. 2020 Aug 21;26(31):4579-4588. https://doi.org/10.3748/wjg.v26.i31.4579
22. Ciceri F, Beretta L, Scandroglio AM, Colombo S, Landoni G, Ruggeri A, Peccatori J, D’Angelo A, De Cobelli F, Rovere-Querini P, Tresoldi M, Dagna L, Zangrillo A. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc. 2020 Apr 15;22(2):95-97. https://doi.org/10.51893/2020.2.pov2
Review
For citations:
Khorobrykh T.V., Protsenko D.D., Kammaev K.A., Petrovskaya A.A., Krylova M.Yu., Sentyurina A.M., Saakyan A.K. COVID-associated pathomorphological changes in the gastric mucosa during gastrointestinal bleeding. Surgical practice (Russia). 2025;(1):12-28. (In Russ.) https://doi.org/10.5922/2223-2427-2025-10-1-2