Gastrointestinal symptoms of COVID-19 in children

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.