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Coronavirus Disease (COVID-19) and the Gastrointestinal System in Children

John Matthai1, Naresh Shanmugam2, Prasanth Sobhan3

  • 1Masonic Medical Centre, Coimbatore, Tamil Nadu, India. Correspondence to: Prof John Matthai, Pediatric Gastroenterologist, Masonic Medical center, Race course, Coimbatore 641004, Tamil Nadu, India. psg_peds@yahoo.com.

Indian Pediatrics
|June 21, 2020
PubMed

Insights

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) can affect the gastrointestinal tract, with prolonged stool positivity suggesting fecal-oral transmission. Children with chronic liver disease or post-transplant should continue regular medication, while elective procedures are deferred.

Area of Science:

  • Gastroenterology
  • Virology
  • Pediatrics

Background:

  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) primarily affects the respiratory system but also impacts the gastrointestinal (GI) tract.
  • Viral entry into GI tissues is facilitated by the co-expression of angiotensin-converting enzyme-2 (ACE-2) and transmembrane serine protease 2 (TMPRSS2) receptors.
  • While less common, pediatric SARS-CoV2 infections can manifest with GI symptoms like diarrhea and vomiting.

Purpose of the Study:

  • To investigate the gastrointestinal manifestations of SARS-CoV2 in children.
  • To assess the risk of severe disease in pediatric patients with pre-existing liver conditions.
  • To provide guidance on managing pediatric patients with GI involvement during the pandemic.

Main Methods:

  • Review of clinical data and viral shedding in stool samples.
  • Analysis of liver enzyme levels in infected children.
  • Evaluation of outcomes in children with chronic liver disease and post-liver transplant status.

Main Results:

  • Prolonged RT-PCR positivity in stool samples suggests potential fecal-oral transmission of SARS-CoV2.
  • Elevated transaminases are frequently observed, particularly in severe cases of coronavirus disease (COVID-19).
  • Children with inflammatory bowel disease and post-liver transplant recipients did not exhibit an increased risk for SARS-CoV2 disease.

Conclusions:

  • SARS-CoV2 can cause gastrointestinal symptoms and prolonged fecal shedding in children.
  • Children with chronic liver conditions should continue their prescribed medications.
  • Elective procedures, such as endoscopy, should be postponed in pediatric patients during the pandemic to minimize exposure risks.

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