Gastrointestinal protection in patients with COVID-19

Tutorial presented by Sarah Gage, Gastro Directorate Pharmacist.

In this tutorial Sarah Gage provides an overview of the GI protection in patients with COVID-19, including a guideline that has been produced for use of Proton Pump Inhibitors for GI protection.

The use of dexamethasone became standard practice in the management of patients with severe COVID-19 requiring ventilation and oxygenation support, and the widely recognised side-effects of dexamethasone were encountered. In order to minimise the risk of gastrointestinal irritation, erosion, ulceration and bleeds, the use of Proton Pump Inhibitors (PPI) was recommended to protect the stomach from injury for the length of the dexamethasone treatment.

The team in Cardiff and Vale UHB produced a guideline outlining the recommendations for GI Protection in patients with COVID-19 (linked below). Recommendations include:

  1. Patients commenced on dexamethasone 6mg daily with concomitant prophylactic or therapeutic doses of anticoagulant should also be prescribed PPI cover with either omeprazole po 40mg daily or Lansoprazole 30mg daily. For patients with swallowing difficulties prescribe omeprazole iv 40mg daily.
  2. PPI cover should continue for the duration of steroid treatment (up to 10 days) and whilst the risk of a bleed remains, and can then be stopped.
  3. Patients admitted already on PPI therapy should have their dose increased in line with above dose recommendations. then reduced back to pre-admission dose on discharge.
  4. Patients with NG tubes who may have issues with gastric stasis (such as critical care patients) should be prescribed intravenous omeprazole 40mg daily initially until gastric absorption recovers. Once steroids are weaned/stopped usual critical care guidelines for those on mechanical ventilation would be followed.
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Resources

Guideline for Gastrointestinal (GI) protection in patients with COVID-19

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