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

J Pediatr Gastroenterol Nutr. 2021 Sep 1;73(3):299-305. doi: 10.1097/MPG.0000000000003204.

Abstract

Gastrointestinal symptoms are common findings in children with severe acute respiratory syndrome coronavirus 2 infection, including vomiting, diarrhoea, abdominal pain, and difficulty in feeding, although these symptoms tend to be mild. The hepato-biliary system and the pancreas may also be involved, usually with a mild elevation of transaminases and, rarely, pancreatitis. In contrast, a late hyper-inflammatory phenomenon, termed multisystem inflammatory syndrome (MIS-C), is characterized by more frequent gastrointestinal manifestations with greater severity, sometimes presenting as peritonitis. Gastrointestinal and hepato-biliary manifestations are probably related to a loss in enterocyte absorption capability and microscopic mucosal damage caused by a viral infection of intestinal epithelial cells, hepatocytes and other cells through the angiotensin conversion enzyme 2 receptor resulting in immune cells activation with subsequent release of inflammatory cytokines. Specific conditions such as inflammatory bowel disease (IBD) and liver transplantation may pose a risk for the more severe presentation of coronavirus disease 2019 (COVID-19) but as adult data accumulate, paediatric data is still limited. The aim of this review is to summarize the current evidence about the effect of COVID-19 on the gastrointestinal system in children, with emphasis on the emerging MIS-C and specific considerations such as patients with IBD and liver transplant recipients.

Publication types

  • Review

MeSH terms

  • COVID-19*
  • Diarrhea
  • Gastrointestinal Diseases* / etiology
  • Humans
  • SARS-CoV-2
  • Systemic Inflammatory Response Syndrome

Supplementary concepts

  • pediatric multisystem inflammatory disease, COVID-19 related