Gastrointestinal involvement in paediatric COVID-19 — from pathogenesis to clinical management: A comprehensive review

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is responsible for the first pandemic of the 21^st century. As found in adults, signs and symptoms related to the disease mainly involve the respiratory tract in the paediatric population. However, a considerable number of children present with gastrointestinal symptoms such as vomiting, abdominal pain, and diarrhea. The purpose of this review is an accurate description, from pathogenesis to clinical presentation, diagnosis and treatment, of COVID-19 effects on the gastrointestinal system at a paediatric age. SARS-CoV-2 can be identified in stool specimens of affected children by real-time polymerase chain reaction techniques. Positivity can last for several weeks after the end of the symptomatic phase. Gastrointestinal signs and symptoms are generally self-limited, can correlate with blood tests and imaging alterations, and may require supportive treatment such as hydration. However, they can precede severe disease manifestations such as the COVID-19-related multisystem inflammatory syndrome. Children belonging to risk categories such as those affected by celiac disease, inflammatory bowel disease, and hepatic disease seem to not have a more severe course than the others, even if they are undergoing immunosuppressant treatment. Medical follow-ups of patients with chronic diseases need to be revised during the pandemic period in order to postpone unnecessary tests, mainly endoscopic ones.

Keywords: SARS-CoV-2, COVID-19, Paediatric, Gastrointestinal, Diarrhea, Hydration

Core Tip: Gastrointestinal signs and symptoms seem to be more common in paediatric coronavirus disease 2019 (COVID-19) compared to adults. Manifestations are generally self-limited, and may only require supportive treatment. In a minority of children, gastrointestinal involvement may precede severe forms such as the multisystem inflammatory syndrome. Conversely to what is expected, the COVID-19 impact on paediatric patients with chronic gastrointestinal diseases is limited, with no need for therapeutic regimen changes. However, the severe acute respiratory syndrome coronavirus 2 pandemic determined multiple variations in routine practice. The use of telemedicine and telehealth can be a solution in order to continue to provide regular follow-up to chronic patients, avoiding the risk of viral transmission.