Paediatric gastrointestinal disorders in SARS-CoV-2 infection: Epidemiological and clinical implications

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is a threat worldwide for individuals of all ages, including children. Gastrointestinal manifestations could be the initial presenting manifestation in many patients, especially in children. These symptoms are more common in patients with severe disease than in patients with non-severe disease. Approximately 48.1% of patients had a stool sample that was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA. Children typically form 1%-8% of all laboratory-confirmed cases of SARS-CoV-2. Gastrointestinal manifestations of COVID-19 in children are not rare, with a prevalence between 0 and 88%, and a wide variety of presentations, including diarrhoea, vomiting, and abdominal pain, can develop before, with or after the development of respiratory symptoms. Atypical manifestations such as appendicitis or liver injury could also appear, especially in the presence of multisystem inflammatory disease. In this review, we discussed the epidemiology of COVID-19 gastrointestinal diseases in children as well as their implications on the diagnosis, misdiagnosis, prognosis, and faecal-oral transmission route of COVID-19 and the impact of gastrointestinal diseases on the gut microbiome, child nutrition, and disease management.

Keywords: COVID-19; Children; Dysbiosis; Faecal-oral transmission; Gastrointestinal diseases; SARS-CoV-2.

Figure 1

Pathogenesis of gastrointestinal infection in coronavirus disease 2019. ACE2: Angiotensin-converting enzyme 2; IFN: Interferon; IgA: Immunoglobulin A; ROS: Reactive oxygen species.