Gastrointestinal manifestations of COVID-19 in children: a systematic review and meta-analysis

Akobeng, Anthony K; Grafton-Clarke, Ciaran; Abdelgadir, Ibtihal; Twum-Barimah, Erica; Gordon, Morris

OBJECTIVES: To summarise the published evidence on the gastrointestinal manifestations of COVID-19 in children and to determine the prevalence of gastrointestinal symptoms. METHODS: In this systematic review and meta-analysis, we searched PubMed, Embase, CINAHL and the WHO’s database of publications on novel coronavirus. We included English language studies that had described original demographic and clinical characteristics of children diagnosed with COVID-19 and reported on the presence or absence of gastrointestinal symptoms. Meta-analysis was conducted using the random-effects model. The pooled prevalence of gastrointestinal symptoms was expressed as proportion and 95% CI. RESULTS: The search identified 269 citations. Thirteen studies (nine case series and four case reports) comprising data for 284 patients were included. Overall, we rated four studies as having a low risk of bias, eight studies as moderate and one study as high risk of bias. In a meta-analysis of nine studies, comprising 280 patients, the pooled prevalence of all gastrointestinal symptoms was 22.8% (95% CI 13.1% to 35.2%; I(2)=54%). Diarrhoea was the most commonly reported gastrointestinal symptom followed by vomiting and abdominal pain. CONCLUSIONS: Nearly a quarter of children with COVID-19 have gastrointestinal symptoms. It is important for clinicians to be aware of the gastrointestinal manifestation of COVID-19. PROSPERO REGISTRATION NUMBER: CRD42020177569.