Gastrointestinal Perspective of Coronavirus Disease 2019 in Children—An Updated Review

Assa, Amit; Benninga, Marc A.; Borrelli, Osvaldo; Broekaert, Ilse; Carpi, Javier Martín de; Saccomani, Marco Deganello; Dolinšek, Jernej; Mas, Emmanuel; Miele, Erasmo; Thomson, Mike; Tzivinikos, Christos

doi:10.1097/mpg.0000000000003204

Cited by 24 publications

(32 citation statements)

References 90 publications

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“…Data on GI manifestations of COVID-19 in the pediatric population seem to be conflicting. Although respiratory tract involvement is a typical clinical manifestation of SARS-COV 2 in adults, GI symptoms are more frequently reported in the pediatric population [51][52][53]. It has been observed that GI manifestations, such as diarrhoea and vomiting, are quite common at the disease presentation although less prominent in comparison to adults [12].…”

Section: Gastrointestinal Symptoms Of Severe Acute Respiratory Syndro...mentioning

confidence: 99%

Gastrointestinal coronavirus disease 2019 manifestations in childhood

Sansotta

Norsa

D’Antiga

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewThe pandemic of coronavirus disease 2019 , caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged and caused a massive global health crisis. The aim of this review is first, to provide the latest evidence on what is known about the pathophysiology and the transmission of SARS-CoV-2 and then to focus on the manifestations of the gastrointestinal (GI) tract in children with COVID-19. Lastly, we summarise the impact of COVID-19 on patients with preexisting GI diseases. Recent findingsEven though the virus is mostly transmitted from human to human via respiratory droplets, ACE2 is known to be expressed throughout the GI tract, and SARS-CoV-2 ribonucleic acid has been isolated from patients' stools. GI symptoms including abdominal pain, diarrhoea and vomiting are frequently reported in paediatric patients. Interestingly, a small number of patients seem to exhibit solely GI symptoms. In addition, a multisystem inflammatory syndrome in children (MIS-C) related to SARS-COV-2 described in children, has a high rate of GI involvement. Several etiopathogenetic mechanisms have been postulated to explain the GI involvement of COVID-19. SummaryClinicians should not underestimate or disregard these early or mild GI symptoms, because the patients may be infected and transmit the virus, or develop a more severe condition such as MIS-C.

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Section: Gastrointestinal Symptoms Of Severe Acute Respiratory Syndro...mentioning

confidence: 99%

Gastrointestinal coronavirus disease 2019 manifestations in childhood

Sansotta

Norsa

D’Antiga

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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“…However, it has been shown that gastrointestinal manifestations are particularly frequent and prominent in children with PIMS-TS/MIS-C [ 6 ]. Thus, it may be challenging to differentiate this condition from an exacerbation of chronic inflammatory conditions including inflammatory bowel disease (IBD) [ 7 , 8 ]. Herein we aimed to present clinical characteristics and difficulties in the management of children with concurrent IBD and PIMS-TS/MIS-C based on our experience with four patients.…”

Section: Introductionmentioning

confidence: 99%

Is It Inflammatory Bowel Disease Flare or Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19?

Krawiec

Opoka-Winiarska

Pac-Kożuchowska

2022

JCM

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Background: Pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multi-system inflammatory syndrome in children (PIMS-TS/MIS-C) is a potentially life-threatening complication of SARS-CoV-2 infection in children. Gastrointestinal manifestations are prominent in children with PIMS-TS/MIS-C. Thus, it is challenging to differentiate this condition from an exacerbation of inflammatory bowel disease (IBD). We aimed to present the clinical characteristics, and diagnostic and therapeutic difficulties in patients with overlapping IBD and PIMS-TS/MIS-C; Methods: We reviewed medical records of children hospitalized due to overlapping IBD and PIMS-TS/MIS-C in a single pediatric hospital from December 2020 to December 2021; Results: There were four children with overlapping IBD flare and PIMS-TS/MIS-C. In three cases, IBD recognition preceded PIMS-TS/MIS-C onset and PIMS-TS/MIS-C occurred during anti-inflammatory therapy of IBD. All children presented with gastrointestinal symptoms at PIMS-TS/MIS-C onset. All patients received IVIG and ASA treatment. In three children there was a need to use steroids to resolve PIMS-TS/MIS-C symptoms. One child was vaccinated against COVID-19; Conclusions: SARS-CoV-2 infection may affect patients with underlying inflammatory conditions such as IBD, inducing systemic symptoms of PIMS-TS/MIS-C, and probably triggering IBD after PIMS-TS/MIS-C. The resemblance of clinical presentations is the main source of diagnostic and therapeutic challenges in PIMS-TS/MIS-C in patients with underlying IBD.

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“…The respiratory syndrome (fever, cough, respiratory difficulties) is the main feature and thus the main target for clinical screening of children with suspected COVID-19 [ 5 , 6 , 7 , 8 , 9 , 10 ]. Gastrointestinal (GI) symptoms related to COVID-19, such as vomiting, diarrhea, and abdominal pain, have emerged among extrapulmonary manifestations [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Limited Additive Diagnostic Impact of Isolated Gastrointestinal Involvement for the Triage of Children with Suspected COVID-19

et al. 2022

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The strategy for the selection of patients with a suspected SARS-CoV-2 infection is relevant for the organization of a children’s hospital to provide optimal separation into COVID-19 and non-COVID-19 areas and pathways. We analyzed the proportion of children with COVID-19 presenting with gastrointestinal (GI) symptoms in 137 consecutive patients admitted between January 2020 and August 2021. GI symptoms were present as follows: diarrhea in 35 patients (26%), vomiting in 16 (12%), and both of them in five (3%); the combination of fever, respiratory symptoms, and diarrhea was observed in 16 patients (12%). Of the 676 adult patients with COVID-19 admitted to our hospital in the same time interval, 62 (9.2%) had diarrhea, 30 (4.4%) had vomiting, and 11 (1.6%) had nausea; only one patient, a 38-year-old male, presented with isolated GI symptoms at the diagnosis. Although diarrhea was observed in one quarter of cases, one-half of them had the complete triad of fever, respiratory syndrome, and diarrhea, and only five had isolated diarrhea, of which two were diagnosed with a Campylobacter infection. The occurrence of either respiratory symptoms or gastrointestinal symptoms in our patients was not related to the patient age, while younger children were more likely to have a fever. Of the 137 patients, 73 (53%) could be tested for their serum level of SARS-CoV-2 specific IgG antibodies. The observed titer ranged between 0 (n = 3) and 1729 BAU/mL (median, 425 BAU/mL). Of 137 consecutive patients with COVID-19 admitted to our referral children’s hospital, only three presented with an isolated GI manifestation. It is interesting to note that this finding turned out to be fully in keeping with what was observed on adult patients with COVID-19 in our hospital. The additive diagnostic impact of gastrointestinal involvement for the triage of children with suspected COVID-19 appears limited.

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Gastrointestinal Perspective of Coronavirus Disease 2019 in Children—An Updated Review

Cited by 24 publications

References 90 publications

Gastrointestinal coronavirus disease 2019 manifestations in childhood

Gastrointestinal coronavirus disease 2019 manifestations in childhood

Is It Inflammatory Bowel Disease Flare or Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19?

Limited Additive Diagnostic Impact of Isolated Gastrointestinal Involvement for the Triage of Children with Suspected COVID-19

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