key: cord-0972005-smbi4d01
authors: Chen, Tai-Heng; Kao, Wei-Tsun; Tseng, Yung-Hao
title: Gastrointestinal involvements in children with COVID-related multisystem inflammatory syndrome
date: 2020-07-02
journal: Gastroenterology
DOI: 10.1053/j.gastro.2020.06.084
sha: 924ff639c8269360df01d42281fd7e9d5acad679
doc_id: 972005
cord_uid: smbi4d01

nan

infection and may occur in the absence of any respiratory symptoms. As SARS-Cov-2 can also infect enterocytes through an angiotensin system by binding the angiotensin-converting enzyme 2 receptors, digestive symptoms might present in 50.5% of adult patients. Compared with adults, 13% of COVID-19-infected children are reported to have diarrhea, followed by nausea/vomiting (11%) and abdominal pain (6%). 2 Besides the report of Miller et al., We have reviewed recent studies that describe pediatric cases diagnosed with Kawasaki-like MIS-C, who also presented with a variety of gastrointestinal symptoms and signs. [3] [4] [5] [6] [7] [8] Strikingly, we found that 90% of 72 children with MIS-C, which was higher than the Miller's report, had gastrointestinal manifestations, most of which consisted of abdominal pain, vomiting, and diarrhea (Table 1) . Besides, 10% of MIS-C cases had some rare presentations mimicking appendicitis and peritonitis, of which three cases were surgically explored. In contrast, only 2.3-4.6 % of children with classical Kawasaki disease have been reported complicated with gastrointestinal involvement.

The high incidence of gastrointestinal involvement in MIS-C cases is unclear. The most plausible pathomechanism might be attributed to the overwhelming multi-organ 3 inflammation, including the digestive system. This hypothesis might be further substantialized by the significantly high inflammatory markers and positive SARS-Cov-2 antibodies in the serum of most children, but negative viral RT-PCR in nasopharyngeal swab or feces. Furthermore, the gastrointestinal investigations also showed mesenteric lymphadenitis and serous effusions (ascites) in severe cases, which implied that an active inflammatory reaction occurred in the digestive systems. However, a recent study on COVID-related gastrointestinal involvement showed that up to 41% of children without MIS-C had positive SARS-Cov-2 RT-PCR in feces. 9 This finding may also reflect that the high incidence of gastrointestinal symptoms in MIS-C cases is likely due to the heightened inflammatory response.

Conclusively, our summary suggests that the gastrointestinal manifestations should not be overlooked in children with COVID-related MIS-C, and meticulous evaluation of the inflammatory response of the digestive system is essential to prevent unnecessary exploratory surgical intervention.

The authors declare that there is no conflict of interest.

This article does not contain any studies involving human participants performed by any of 

Lancet Child Adolesc Health 2020

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