Letter to the Editor
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2021; 27(40): 7000-7004
Published online Oct 28, 2021. doi: 10.3748/wjg.v27.i40.7000
Gastrointestinal and hepatic involvement during COVID-19 pandemic: A focus on pediatric population and possible future implications
Rossella Sica, Serena Pennoni, Laura Penta, Sara Riccioni, Giuseppe Di Cara, Alberto Verrotti
Rossella Sica, Serena Pennoni, Laura Penta, Sara Riccioni, Giuseppe Di Cara, Alberto Verrotti, Department of Pediatrics, University of Perugia, Perugia 06132, PG, Italy
Author contributions: Sica R drafted the manuscript; Sica R, Pennoni S, Penta L, Riccioni S, Di Cara G and Verrotti A edited and revised the manuscript; Verrotti A supervised and approved the final version of the manuscript; all authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alberto Verrotti, MD, PhD, Chief Doctor, Professor, Department of Pediatrics, University of Perugia, Piazza L Severi 1, Perugia 06132, PG, Italy. alberto.verrottidipianella@unipg.it
Received: August 5, 2021
Peer-review started: August 5, 2021
First decision: August 19, 2021
Revised: August 30, 2021
Accepted: September 15, 2021
Article in press: September 15, 2021
Published online: October 28, 2021

Since the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide, there is still limited knowledge about this condition and its natural history. Children have been relatively spared during COVID-19 pandemic but a novel syndrome known as multisystem inflammatory syndrome (MIS-C) has emerged, following a SARS-CoV-2 infection in children and adolescents. This syndrome can lead to shock and multiple organ failure requiring intensive care. Although COVID-19 clinical research focuses on respiratory symptoms, extrapulmonary involvement such as gastrointestinal (GI) and hepatic manifestations should also be considered. In fact, GI and hepatic involvement play an important role among the most common presenting symptoms of both pediatric and adult COVID-19 and MIS-C. This involvement can not only be one of the most common presenting clinical features but also one of the sequelae of these syndromes. Abdominal ultrasonography monitoring could be very useful to identify a potential involvement of the GI tract and liver. Moreover, long-term follow-up is needed and would be essential to define the long-term outcomes of these patients.

Keywords: SARS-CoV-2, COVID-19, Multisystem inflammatory syndrome, Gastrointestinal tract, Liver, Ultrasonography

Core Tip: Gastrointestinal and hepatic symptoms are a common clinical feature of the coronavirus disease 2019 (COVID-19). Moreover, a novel syndrome known as multisystem inflammatory syndrome (MIS-C) associated with COVID-19 in children and adolescents has emerged. Among the most common presenting symptoms of MIS-C, we found gastrointestinal and hepatic involvement. As gastrointestinal and hepatic involvement might play a major role in the clinical spectrum and possible sequelae of this novel condition, physicians should not underestimate these clinical manifestations. Therefore, abdominal ultrasonography monitoring and long-term follow-up could be useful to evaluate this potential damage and the possible outcome of these patients.