Introduction: Upper gastrointestinal bleeding (UGIB) is among the most common causes of morbidity and mortality worldwide, accounting for major resource allocation and increasing incidence. This study aimed to evaluate the severity of non-variceal bleeding in patients at risk of bleeding through the use of NSAIDs, oral anticoagulants, and antiplatelet therapy. Material and Method: The study included 296 patients admitted in the Gastroenterology Department of the Municipal County Emergency University Hospital, Timisoara, between 01.01.2018 and 01.04.2020, and diagnosed via gastroscopy with non-variceal gastrointestinal bleeding. The patients were divided among four groups based on their use of different drugs known to induce UGIB, i.e., aspirin and clopidogrel, NOACs, NSAIDs, and anti-vitamin K drugs, respectively. Statistical analyses were performed based on ANOVA one-way tests for continuous variables and Chi-square tests for categorical variables with pairwise comparisons based on Bonferroni adjusted significance tests. Results: The results showed several parameters having statistical significance among the different groups of patients. Patients on NOACs had statistically significant lower hemoglobin levels, lower hematocrit values, lower erythrocytes, lower RDW and higher fibrinogen levels compared to patients on VKA. Discussion: Surprisingly, the results from our study suggest that the use of NOACs was associated with a higher risk of bleeding when compared to VKA, which differs from the existing literature. Conclusions: One of the important factors causing upper non-variceal bleeding can be iatrogenic, either due to antiplatelet drugs or anticoagulants, to which NSAID treatment is additionally associated for various reasons. In our study, the use of NOACs seemed to have a more severe bleeding spectrum with higher morbidity compared to VKA.

Background and Objectives: The COVID-19 pandemic profoundly disrupted global healthcare systems, limiting access to diagnostic and therapeutic services for chronic diseases. Patients with decompensated liver cirrhosis were particularly vulnerable due to their fragile clinical status and dependence on continuous medical care. This study aimed to evaluate the temporal evolution of clinical, biological, and prognostic parameters in patients admitted emergently with decompensated liver cirrhosis across three distinct phases: pre-pandemic, pandemic, and post-pandemic. Materials and Methods: A retrospective, single-center study was conducted at the Department of Gastroenterology, Municipal Clinical Emergency Hospital, Timișoara, Romania, including 355 patients hospitalized between February 2018 and February 2024. Clinical, biochemical, and outcome data were collected and analyzed using univariate and multivariate logistic regression models to identify independent predictors of in-hospital mortality for each study period. Results: Significant temporal variations were observed in disease severity, management, and outcomes. The mean MELD score increased from 18.7 to 21.0 during the pandemic (p = 0.043), while endoscopic evaluations declined markedly (59.4% pre-pandemic vs. 42.7% pandemic, p = 0.037). Mortality rose from 21.7% to 30.2% during the pandemic (p = 0.044) and remained elevated post-pandemic (26.4%). Multivariate regression identified Child–Pugh, MELD, and Baveno scores as consistent mortality predictors, though their relative weight varied by period. During the pandemic, acute complications—particularly jaundice (OR = 294) and upper gastrointestinal bleeding (OR = 355)—became dominant determinants of death. Conclusions: The pandemic transformed cirrhosis from a chronic, manageable disease into an acutely unstable condition, primarily due to delayed presentation and restricted procedural access. Although post-pandemic recovery was evident, residual increases in mortality and severity indicate lasting effects of healthcare disruption, underscoring the need to strengthen system resilience and continuity of care for patients with chronic liver disease.

Background: Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, had profound primary effects on global health and secondary effects through widespread disruption of healthcare systems, limiting access to elective medical services essential for the management of chronic diseases such as liver cirrhosis. Elective hospitalizations play a key role in disease monitoring, prevention of complications, and therapeutic optimization. This study aimed to evaluate the impact of the pandemic on the clinical profile, disease severity, and outcomes of patients electively admitted with liver cirrhosis across three periods: pre-pandemic, pandemic, and post-pandemic. Methods: This retrospective, single-center cohort study included 248 adult patients electively admitted with a primary diagnosis of liver cirrhosis between February 2018 and February 2024. Patients were stratified according to admission period. Data on demographics, clinical presentation, etiology, decompensation markers, severity scores (Child–Pugh, Baveno), procedures, and hospitalization outcomes were analyzed. Results: A total of 248 patients were included, with a significant reduction in elective admissions during the pandemic (23.0% vs. 46.4% pre-pandemic), followed by partial recovery post-pandemic (30.6%) (p = 0.031). A higher proportion of urban patients was observed during the pandemic (70.2%, p = 0.004). Disease severity increased during the pandemic, with a higher prevalence of Child–Pugh C (17.5%) and Baveno stage 6 (10.5%), whereas post-pandemic data showed improvement (Child–Pugh C: 6.57%; no Baveno stage 6; p = 0.004). Ascites (47.4%) and paracentesis (21.1%) peaked post-pandemic (p = 0.012; p = 0.003). Endoscopic activity decreased during the pandemic (22.8%, p = 0.017), while interventional procedures were more frequent (8.8%, p = 0.045). Transfusion requirements (17.5%, p = 0.001) and hospitalization costs (€467.08, p = 0.01) were highest during the pandemic, while no deaths were recorded post-pandemic. In-hospital mortality was observed in 1.7% of patients during the pre-pandemic period and increased to 3.5% during the pandemic period, while no deaths were recorded post-pandemic. Conclusions: The COVID-19 pandemic significantly altered elective cirrhosis care, leading to reduced admissions, increased disease severity, and higher resource utilization. Although partial recovery was observed post-pandemic, persistent evidence of delayed decompensation underscores the importance of maintaining continuity in elective hepatology services.