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.

The Impact of SARS-CoV-2 Infection in Patients with Inborn Errors of Immunity: the Experience of the Italian Primary Immunodeficiencies Network (IPINet)

“…The most common symptom reported in patients not requiring hospital admission was fever followed by general symptoms and respiratory symptoms. Gastrointestinal symptoms were more rarely observed, and, differently from what observed in the general population, there was no difference among adults and children in the incidence of gastrointestinal symptoms [ 21 , 22 ]. In our pediatric cohort, we did not identify any case of multisystem inflammatory syndrome in children (MIS-C).…”

Celiac Disease and Targeting the Molecular Mechanisms of Autoimmunity in COVID Pandemic

“…Monitoring CD patients must be adapted to the pandemic to avoid unnecessary endoscopic examinations and duodenal biopsies. Telemedicine can be a good alternative for educating and monitoring chronic patients, keeping away from the risk of unwarranted interventions and viral transmission [ 95 ].…”

COVID-19: gastrointestinal and hepatobiliary manifestations

“…A second proposed mechanism of GI and hepatobiliary injury involves inflammatory and immune mediators. COVID-19 disease has been associated with markedly increased levels of inflammatory markers and cytokines, including interleukin-1 (IL-1), IL-6, and tumor necrosis factor-alpha (TNF-α), which may lead to an accumulation of immune cells in the GI tract [ 76 ] and induce hepatocellular cholestasis by downregulating hepatobiliary uptake and excretory systems. [ 77 , 78 ] Some authors have suggested that immunosuppression is beneficial in blunting cytokine release, leading to improved outcomes.…”