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Gastrointestinal System Involvement in Pediatric Patients with Acute SARS-CoV-2 Infection
Ozlem Kalaycik Sengul1, Burcin Beken2, Zehra Ozturk3
1University of Health Sciences Turkey, Kanuni Sultan Suleyman Training and Research Hospital, Clinic of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul, Turkey.
Insights
Gastrointestinal system involvement in pediatric coronavirus disease-2019 (COVID-19) is more common in younger children and associated with a milder disease course. Respiratory symptom severity and intensive care unit admissions decreased with accompanying gastrointestinal system involvement.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Virology
Background:
- Gastrointestinal symptoms are frequently reported in coronavirus disease-2019 (COVID-19) patients.
- The involvement of the gastrointestinal system (GIS) in pediatric COVID-19 and its impact on disease prognosis require further investigation.
Purpose of the Study:
- To investigate the prevalence of gastrointestinal system involvement in pediatric COVID-19.
- To determine the effect of gastrointestinal system involvement on the prognosis of pediatric COVID-19.
Main Methods:
- A cohort of 223 pediatric patients (aged 0-18 years) with acute COVID-19 was analyzed.
- Patients were categorized into isolated respiratory system (RS), isolated GIS, and combined RS+GIS involvement groups.
- Demographic, clinical, laboratory, imaging, and hospitalization data were compared across groups.
Main Results:
- Gastrointestinal system involvement was observed in 6.3% of patients, with 22.9% having combined respiratory and GIS involvement.
- The GIS group was significantly younger than the RS group (median 30 vs. 150 months, p=0.006).
- Severe-critical respiratory symptoms and intensive care unit admissions were less frequent in patients with GIS involvement.
Conclusions:
- Gastrointestinal system involvement in pediatric COVID-19 is more prevalent in younger children.
- Accompanying gastrointestinal system involvement is associated with reduced respiratory symptom severity and lower intensive care unit admission rates.
- Gastrointestinal system involvement correlates with a milder disease course in pediatric COVID-19, even after adjusting for age.
Objective:
The prevalence of gastrointestinal symptoms in coronavirus disease-2019 (COVID-19) has been reported widely. In this study, the prevalence of gastrointestinal system (GIS) involvement in pediatric COVID-19 and its effect on prognosis were investigated.
Methods:
Children (aged 0-18 years) with acute COVID-19 were included in the study. The patients were grouped according to system involvement: isolated respiratory system (RS), isolated GIS, and combination of both (RS+GIS). These groups were compared in terms of demographic data, clinical characteristics, laboratory and imaging findings, and hospitalization.
Results:
A total of 223 pediatric patients were included in the study. Of these patients, 19 were asymptomatic, 12 were diagnosed with a multisystem inflammatory syndrome in children, 21 had chronic disorders that may affect disease severity, and 27 had symptoms not related to RS or GIS. The remaining 144 patients were classified according to system involvement: 79 (35.4%), 14 (6.3%), and 51 (22.9%) had isolated RS, isolated GIS, and RS+GIS involvement, respectively. The GIS group was much younger than the RS group (median, 30 and 150 months, respectively, p=0.006). Three patients from the RS group were followed in the intensive care unit (ICU). Moreover, 17 (21.5%) and 4 (7.8%) patients from the RS group had severe-critical respiratory symptoms, in the RS+GIS group had severe-critical respiratory symptoms (p=0.039).
Conclusions:
Our study showed that GIS involvement in children with COVID-19 is more prevalent than RS involvement in the younger age group. Respiratory symptom severity and ICU admission also decreased with accompanying GIS involvement. GIS involvement was still associated with a milder disease course after adjustment for age.
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