Abstract
Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV2), though primarily a respiratory pathogen, also involves the gastrointestinal tract. Similar to the respiratory mucosa, angiotensin converting enzyme-2 (ACE-2) receptor and transmembrane serine protease 2 (TMPRSS2) co-express in the gastrointestinal tract, which facilitates viral entry into the tissue. Less than 10% of children with infection develop diarrhea and vomiting. Prolonged RT PCR positivity in the stool has raised the possibility of feco-oral transmission. Elevated transaminases are common, especially in those with severe coronavirus disease (COVID-19). Children with inflammatory bowel disease and post liver transplant patients do not have an increased risk of disease, and should remain on medications they are already on. Children with chronic liver disease should continue their medications as usual. All elective procedures like endoscopy should be postponed.
Keywords: Diarrhea, Fecal shedding, Inflammatory bowel disease, Liver transplant, SARSCoV-2
Contributors
JM: as chairman coordinated and edited the paper; NS authored the segment on Liver; PS the segment on intestine. All authors participated in finalizing the paper.
References
- 1.Hindson J. COVID-19: Faecal-oral transmission? Nature Rev Gastroenterol Hepatol. 2020. Available from https://www.nature.com/nrgastro/s41575-020-0295-7. Accessed March 30, 2020. [DOI] [PMC free article] [PubMed]
- 2.Xu Y, Li X, Zhu B, Liang H, Fang C, Gong Y,et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nature Med.2020. Available from: https://www.nature.com/naturemedicine/s41591-020-08174. Accessed March 15,2020. [DOI] [PMC free article] [PubMed]
- 3.Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 infection in children. New England J Med. 2020. Available from: https://www.nejm.org/NEJMc2005073. Accessed March 29, 2020. [DOI] [PMC free article] [PubMed]
- 4.Jin X, Lian J-S, Hu JH, Gao J, Zheng L, Zhang YM, et al. Epidemiological, clinical and virological characteristics of 74 cases of corona virus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut.2020. Available from: https://gut.bmj.com/gutjnl-2020-320926. Accessed March 20, 2020. [DOI] [PMC free article] [PubMed]
- 5.Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H.Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020. Available from: https://www.gastrojournal.org/j.gastro.2020.02.05. Accessed March 27, 2020. [DOI] [PMC free article] [PubMed]
- 6.Pan L, Mu M, Ren HG, Yang P, Sun Y, Wang R,et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: A descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020. Available from: https://journals.lww.com/ajg/ajg.0000000000000620. Accessed March 31, 2020. [DOI] [PMC free article] [PubMed]
- 7.Danese S, Cecconi M, Spinelli A. Management of IBD during the COVID-19 outbreak: Resetting clinical priorities. Nature Rev Gastroenterol Hepatol.2020. Available from: https://www.nature.com/nrgastro/s41575-020-0294-8. Accessed March 30, 2020. [DOI] [PMC free article] [PubMed]
- 8.Mao R, Liang J, Shen J, Ghosh S, Zhu LR,Yang H, et al on behalf of the Chinese Society of IBD, Chinese Elite IBD Union, and Chinese IBD Quality Care Evaluation Center Committee. Implications of COVID-19 for patients with pre-existing digestive diseases. Lancet Gastroenterol Hepatol. 2020. Available from: https://www.thelancet.com/langas/S2468-1253(20)30076-5. Accessed March 30, 2020. [DOI] [PMC free article] [PubMed]
- 9.Zhang c, Shi 1, Wang F-S. Liver injury in COVID-19: Management and challenges. Lancet Gastroenterol Hepatol. 2020. Available from: https://www.thelancet.com/gastrohep>S246812532030057-1. Accessed April 06, 2020. [DOI] [PMC free article] [PubMed]
- 10.Bangash MN, Patel J, Patrekh D. COVID-19 and the liver: Little cause for concern. Lancet GastroenterolHepatol. 2020. https://www.thelancet.com/gastrohepS2468-1253(20)30084-4. Accessed April 06, 2020. [DOI] [PMC free article] [PubMed]