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Review
. 2021 Feb 22:9:617980.
doi: 10.3389/fped.2021.617980. eCollection 2021.

SARS-CoV-2 and the Gastrointestinal Tract in Children

Maria Giovanna Puoti  1 , Anna Rybak  1 , Fevronia Kiparissi  1 , Edward Gaynor  1 , Osvaldo Borrelli  1
Affiliations
Review

SARS-CoV-2 and the Gastrointestinal Tract in Children

Maria Giovanna Puoti et al. Front Pediatr. .

Abstract

Coronavirus disease 2019 (COVID-19), caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is predominantly a respiratory disease. However, its significant impact on the gastrointestinal (GI) system is now well-known. SARS-CoV-2 enters cells via the angiotensin-converting enzyme-2 (ACE-2) receptor, which is abundantly expressed on lung cells, but also on enterocytes. Several etiopathogenetic mechanisms have been postulated to explain the GI involvement in COVID-19, including loss in intestinal absorption, microscopic mucosal inflammation and impaired ACE-2 function, which plays a significant role in maintaining gut homeostasis. In children the GI manifestations include anorexia, nausea, vomiting, diarrhea and abdominal pain, which may represent the earliest presenting symptoms of the disease. However, although rare, a significant GI mucosal inflammation, such as terminal ileitis mimicking an atypical appendicitis, and other GI manifestations have been reported. COVID-19 pandemic has posed a significant challenge in healthcare provision in term of ability in providing safe diagnostic procedures, face-to-face consultations, and offering comprehensive care. For instance, changes in health services have raised the risk of empirical or sub-optimal management of chronic GI disorders such as inflammatory bowel disease (IBD) due to delayed endoscopic and clinical assessment. This review will discuss the acute GI involvement in COVID-19 in children and reflect on challenges and major changes observed in clinical practice during COVID-19 pandemic by sharing both the published literature and personal experience. We also suggest potential strategies for providing optimal gastroenterology care during this unprecedented era.

Keywords: COVID-19; SARS-CoV-2; children; gastrointestinal symptoms; gut; pediatric gastroenterology.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Methodology for literature review.
Figure 2
Figure 2
Proposed pathophysiologic mechanisms of gastrointestinal symptoms associated with COVID-19 infection. ENS, enteric nervous system; ACE-2, angiotensin-converting enzyme-2.
Figure 3
Figure 3
Strategies for managing gastrointestinal conditions during COVID-19 pandemic.
See this image and copyright information in PMC

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