ORIGINAL PAPER
Gastrointestinal symptoms of COVID-19 in children
1
Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznań, Poland
2
Department of Paediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
Submission date: 2022-04-07
Final revision date: 2022-06-04
Acceptance date: 2022-06-08
Publication date: 2022-12-30
Pediatr Pol 2022;97(4):296-301
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The COVID-19 pandemic progresses. The clinical manifestation of the disease and the severity of its course vary significantly. There are considerable differences between symptoms of SARS-CoV-2 infection in the child and adult populations. The gastrointestinal (GI) symptoms are an essential element in understanding the pathophysiology of the disease and in drawing conclusions concerning the diagnostic, therapeutic, and epidemiological management of COVID-19. The aim of the study was to characterize the gastroenterological symptoms of COVID-19 in the paediatric population and to find differences in the course of the disease between paediatric patients with and without GI symptoms of COVID-19.
Material and methods:
We report the clinical characteristics of 321 children with COVID-19 (age 0–215 months) hospitalized between March 2020 and April 2021. The following division was used when processing the data: the first wave of cases in Poland lasted from the beginning of the pandemic to June 2020, the 2nd wave September-November 2020, and the 3rd wave February-May 2021. We specifically compared the differences between patients with and without GI symptoms.
Results:
Among all included patients, 95 (29.5%) had GI symptoms – the most common included abdominal pain (15.27%) and diarrhoea (14%). Approximately 3% of patients with GI symptoms required surgical intervention. As the pandemic progressed, GI symptoms were reported with increasing frequency – during the first wave 9%, the second wave 25%, and the third wave 38%. Patients with GI symptoms had more frequent and statistically significantly higher inflammatory parameters. During treatment, GI patients more often required the administration of antibiotics. The most common abdominal ultrasound abnormalities were liver enlargement, a slight amount of free fluid in the peritoneal cavity, and moderately enlarged individual lymph nodes.
Conclusions:
Gastrointestinal symptoms form an image of COVID-19, which is a possible prognostic risk factor for severe course of the disease. Gastrointestinal symptoms should be treated as a possible isolated image of COVID-19.
The COVID-19 pandemic progresses. The clinical manifestation of the disease and the severity of its course vary significantly. There are considerable differences between symptoms of SARS-CoV-2 infection in the child and adult populations. The gastrointestinal (GI) symptoms are an essential element in understanding the pathophysiology of the disease and in drawing conclusions concerning the diagnostic, therapeutic, and epidemiological management of COVID-19. The aim of the study was to characterize the gastroenterological symptoms of COVID-19 in the paediatric population and to find differences in the course of the disease between paediatric patients with and without GI symptoms of COVID-19.
Material and methods:
We report the clinical characteristics of 321 children with COVID-19 (age 0–215 months) hospitalized between March 2020 and April 2021. The following division was used when processing the data: the first wave of cases in Poland lasted from the beginning of the pandemic to June 2020, the 2nd wave September-November 2020, and the 3rd wave February-May 2021. We specifically compared the differences between patients with and without GI symptoms.
Results:
Among all included patients, 95 (29.5%) had GI symptoms – the most common included abdominal pain (15.27%) and diarrhoea (14%). Approximately 3% of patients with GI symptoms required surgical intervention. As the pandemic progressed, GI symptoms were reported with increasing frequency – during the first wave 9%, the second wave 25%, and the third wave 38%. Patients with GI symptoms had more frequent and statistically significantly higher inflammatory parameters. During treatment, GI patients more often required the administration of antibiotics. The most common abdominal ultrasound abnormalities were liver enlargement, a slight amount of free fluid in the peritoneal cavity, and moderately enlarged individual lymph nodes.
Conclusions:
Gastrointestinal symptoms form an image of COVID-19, which is a possible prognostic risk factor for severe course of the disease. Gastrointestinal symptoms should be treated as a possible isolated image of COVID-19.
REFERENCES (26)
2.
Da Rosa Mesquita R, Francelino Silva Junior LC, Santos Santana FM, et al. Clinical manifestations of COVID-19 in the general population: systematic review. Wien Klin Wochenschr 2021; 133: 377-382.
3.
Mania A, Mazur-Melewska K, Lubarski, K, et al. Wide spectrum of clinical picture of COVID-19 in children – from mild to severe disease. J Infect Public Health 2021; 14: 374-379.
4.
Tabarkiewicz J, Frączek P, Guoqian C, et al. Advancement of SARS-CoV-2 infection in children. Pol J Paediatr 2021; 96: 129-133.
5.
Patel NA. Pediatric COVID-19: systematic review of the literature. Am J Otolaryngol 2020; 41: 102573.
6.
Akobeng AK, Grafton-Clarke C, Abdelgadir, et al. Gastrointestinal manifestations of COVID-19 in children: a systematic review and meta-analysis. Frontline Gastroenterol 2021; 12: 332-337.
7.
Duarte-Salles T, Vizcaya D, Pistillo A, et al. Thirty-day outcomes of children and adolescents with COVID-19: an international experience. Pediatrics 2021; 148: e2020042929.
8.
Bourgonje AR, Abdulle AE, Timens W, et al. Angiotensin converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID‐19). J Pathol 2020; 251: 228-248.
9.
Pola A, Murthy KS, Santhekadur PK, et al. COVID-19 and gastrointestinal system: a brief review. Biomed J 2021; 44: 245-251.
10.
South AM, Diz DI, Chappell MC. COVID-19, ACE2, and the cardiovascular consequences. Am J Physiol Heart Circ 2020; 318: H1084-H1090.
11.
Zhang H, Kang ZJ, Gong HY, et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. bioRxiv 2020; 927806.
12.
Wong SH, Lui RN, Sung JJ. COVID-19 and the digestive system. J Gastroenterol Hepatol 2020; 35: 744-748.
13.
Cheung KS, Hung IF, Chan PP, et al. Gastrointestinal manifestationsof SARS-CoV-2 infection and virus load in fecal samples from the Hong Kong cohort and systematic review and meta-analysis. Gastroenterology 2020; 159: 81-95.
14.
Muus C, Luecken MD, Eraslan G, et al. Single-cell meta-analysis of SARS-CoV-2 entry genes across tissues and demographics. Nat Med 2021; 27: 546-559.
15.
Zhang M, Zhou Y, Li H, et al. COVID-19: gastrointestinal symptoms from the view of gut-lung axis. Eur J Gastroenterol Hepatol 2021; 33: 610-612.
16.
Mitsuyama K, Tsuruta K, Takedatsu H, et al. Clinical features and pathogenic mechanisms of gastrointestinal injury in COVID-19. J Clin Med 2020; 9: 3630.
17.
Ghoshal UC, Ghoshal U, Mathur A, et al. The spectrum of gastrointestinal symptoms in patients with coronavirus disease-19: predictors, relationship with disease severity, and outcome. Clin Transl Gastroenterol 2020; 11: e00259.
18.
Giacomet V, Barcellini L, Stracuzzi M, et al. Gastrointestinal symptoms in severe COVID-19 children. J Pediatr Infect Dis 2020; 39: e317-e320.
19.
Bergogne-Berezin E. Treatment and prevention of antibiotic associated diarrhea. Int J Antimicrob Agents 2000; 16: 521-526.
20.
Bossert E. Stress appraisals of hospitalized school-age children. Children’s Health Care 1994; 23: 33-49.
21.
Mao R, Qiu Y, He JS, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta‐analysis. Lancet Gastroenterol Hepatol 2020; 5: 667-678.
22.
Calinescu AM, Vidal I, Grazioli S, et al. Beware of too aggressive approach in children with acute abdomen during COVID-19 outbreak! Ann Surg 2020; 272: e244.
23.
Schneider A, Kirsten H, Lordick F, et al. COVID-19 in outpatients – is fever a useful indicator for SARS-CoV-2 infection? PloS One 2021; 16: e0246312.
24.
Andrews PL, Cai W, Rudd JA, et al. COVID-19, nausea, and vomiting. J Gastroenterol Hepatol 2021; 36: 646-656.
25.
Wang Y, Chen R, Hu F, et al. Transmission, viral kinetics and clinical characteristics of the emergent SARS-CoV-2 Delta VOC in Guangzhou, China. EClinicalMedicine 2021; 40: 101129.
26.
Feng X, Li S, Sun Q, et al. Immune-inflammatory parameters in COVID-19 cases: a systematic review and meta-analysis. Front Med 2020; 7: 301.
Share
RELATED ARTICLE
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
