Introduction
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), associated
with the ongoing coronavirus disease 2019 (COVID-19) pandemic, is
spreading at a remarkable high rate, with more than 5 million subjects
infected worldwide. Children represented approximately 2% of all
cases.1 The available data suggest that mild forms are
more frequent in children than adults, and the percentage of severe
cases, requiring admission to intensive care unit and/or mechanical
ventilation, accounts for about 1% of overall pediatric
cases.1 Few deaths have also been
reported.1 However, it is under debate whether this
low percentage is due to lower susceptibility to infection among
children with respect to adults or similar infection rates but higher
proportions of asymptomatic cases. Since children with no symptoms or
paucisymptomatic forms are less likely to be tested, exact population
denominators are absent, and accurate estimates cannot be calculated.
The proportion of various symptoms reported in pediatric case-series
varies, and it is also affected by the definition of the case, the
number of diagnostic tests performed, and the study setting. A recent
systematic review, including 18 studies and 1065 children, showed that
the most frequently reported symptoms are cough, fever, pharyngitis, and
rhinorrhea, with varying percentages among studies.2Other frequently observed symptoms were headaches, myalgia, rash,
conjunctivitis, syncopal episodes, and gastrointestinal manifestations
such as vomiting, diarrhea, abdominal pain, and difficulty in feeding.
Kawasaki-like syndrome, probably representing a post-infectious
inflammatory syndrome, is also reported.3 Hereby, we
review and discuss the available literature regarding the
gastrointestinal involvement in children with SARS-CoV-2 infection.