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BACKGROUND: Since it was first recognized, Coronavirus Disease 2019 (COVID-19) has become a pandemic, with an estimated 27 million cases and over 800 000 deaths globally. The most common symptoms of the disease are respiratory and constitutional. However, gastrointestinal symptoms (GIS) such as nausea, vomiting, loss of appetite and abdominal pain are also common symptoms in COVID-19, reported in up to 33% of patients. Reports of gastrointestinal bleeding in the literature among SARS-CoV-2-infected patients are limited but increasingly being reported, and the potential mechanism is poorly understood. We present here a series of laboratory confirmed SARS-CoV-2 viral illness with gastrointestinal bleeding (GIB).
CASE REPORT: From March 26th, 2020 through May 25th, 2020, we identified 6 patients with lab-confirmed SARS-CoV-2 and GI bleeding episodes. These patients were managed at multiple centers and were identified via mandated reporting of cases to the health department. The age range of these patients was 77 to 102 years old, and the majority had multiple comorbid conditions. The most common presentation was coffee-ground emesis and dark stools. Five of the 6 patients presented from nursing homes and 3 of them died as a result of COVID-19.
CONCLUSIONS: GI bleeding is an uncommon and under-appreciated presentation of COVID-19, and clinicians should consider this potential presentation of the disease and implement isolation and treatment protocols early in the course of illness. If an association truly exists, the pathogenesis of GIB in SARS-CoV-2 infection is poorly understood.

Keywords: COVID-19, Gastrointestinal Diseases, Gastrointestinal Hemorrhage