Gastrointestinal Manifestations of Pediatric Coronavirus Disease and Their Relationship with a Severe Clinical Course: A Systematic Review and Meta-analysis.

Abstract

BackgroundData on the gastrointestinal (GI) manifestations of Pediatric Corona Virus Disease (COVID-19) is conflicting and the relationship between GI involvement and the severity of COVID-19 disease has not been evaluated. The objectives of this systematic review was to determine the GI manifestations of pediatric COVID-19 and to evaluate their role as risk factors for a severe clinical course.MethodsA systematic literature search was carried out in PubMed and Scopus for studies published before December 31, 2020 with information about the GI manifestations of pediatric COVID-19. Patients with a severe and non-severe clinical course were compared using the inverse variance heterogeneity model and odds ratio (OR) as the effect size. A sensitivity analysis was performed if the heterogeneity was high among studies.ResultsA total of 811 studies were identified through systematic search of which 55 studies (4369 patients) were included in this systematic review. The commonest GI symptoms were diarrhea—19.08%(95%CI : 10.6–28.2), nausea/vomiting 19.7%(95%CI : 7.8–33.2) and abdominal pain 20.3%(95%CI : 3.7–40.4). The presence of diarrhea was significantly associated with a severe clinical course with a pooled OR of 3.97 (95%CI: 1.80–8.73; p < 0.01). Abdominal pain and nausea/vomiting were not associated with disease severity.ConclusionsDiarrhea, nausea/vomiting or abdominal pain are present in nearly one-fifth of all children with COVID-19. The presence of diarrhea portends a severe clinical course.