Gastrointestinal manifestations and nutritional therapy during COVID-19 pandemic: a practical guide for pediatricians

ABSTRACT Coronavirus disease 2019 (COVID-19) is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has spread globally in pandemic proportions. Accumulative evidence suggests SARS-CoV-2 can be transmitted through the digestive system, the so-called fecal-oral route of transmission, and may induce several gastrointestinal manifestations. MEDLINE® and Embase databases were extensively searched for major clinical manifestations of gastrointestinal involvement in children and adolescents with COVID-19 reported in medical literature, and for nutritional therapy-related data. Findings and recommendations were pragmatically described to facilitate overall pediatric approach. A total of 196 studies addressing gastrointestinal or nutritional aspects associated with the global COVID-19 pandemic were found. Of these, only 17 focused specifically on pediatric patients with regard to aforementioned gastrointestinal or nutritional aspects. Most articles were descriptive and six addressed guidelines, established protocols, or expert opinions. Children and adolescents with gastrointestinal symptoms, such as nausea, vomiting and diarrhea, should be seriously suspected of COVID-19. Gastrointestinal signs and symptoms may occur in 3% to 79% of children, adolescents and adults with COVID-19, and are more common in severe cases. These include diarrhea (2% to 50%), anorexia (40% to 50%), vomiting (4% to 67%), nausea (1% to 30%), abdominal pain (2% to 6%) and gastrointestinal bleeding (4% to 14%). Patients with inflammatory bowel disease or chronic liver disease are not at greater risk of infection by SARS-CoV-2 relative to the general population. Nutritional support plays an important role in treatment of pediatric patients, particularly those with severe or critical forms of the disease. The digestive system may be a potential route of COVID-19 transmission. Further research is needed to determine whether the fecal-oral route may be involved in viral spread. Nutritional therapy is vital to prevent malnutrition and sarcopenia in severe cases.

摘要：新型冠状病毒肺炎（Coronavirus Disease 2019, COVID-19）是由严重急性呼吸综合征冠状病毒2型（Severe Acute Respiratory Syndrome Coronavirus 2, SARS-CoV-2）引发的传染性疾病，目前已在全球范围内呈大流行态势。越来越多的累积性研究证据表明，SARS-CoV-2可通过消化系统传播，即所谓的粪-口传播途径，并可能诱发多种胃肠道临床表现。
研究人员对MEDLINE®及Embase数据库进行了全面检索，以获取医学文献中报道的新冠感染儿童及青少年患者胃肠道受累的主要临床表现，以及与营养治疗相关的研究数据。本研究对相关研究结果与建议进行了务实性阐述，以助力儿科临床的整体诊疗方案制定。
最终共检索得到196项针对全球新冠大流行相关胃肠道或营养问题的研究，其中仅17项专门针对上述胃肠道或营养维度的儿科患者展开。
绝大多数研究为描述性研究，另有6项研究聚焦于临床指南、既定诊疗方案或专家共识意见。
对于出现恶心、呕吐、腹泻等胃肠道症状的儿童及青少年，应高度怀疑其感染新冠病毒。
新冠病毒感染的儿童、青少年及成人患者中，胃肠道体征与症状的发生率为3%~79%，且在重症病例中更为常见。此类症状包括腹泻（2%~50%）、食欲减退（40%~50%）、呕吐（4%~67%）、恶心（1%~30%）、腹痛（2%~6%）以及胃肠道出血（4%~14%）。
相较于普通人群，炎症性肠病或慢性肝病患者并未面临更高的SARS-CoV-2感染风险。
营养支持在儿科新冠患者的治疗中发挥着重要作用，尤其是重症及危重症患儿。
消化系统或可成为新冠病毒的潜在传播途径。
未来仍需开展进一步研究以明确粪-口传播是否参与病毒的播散过程。
营养治疗对于预防重症患者出现营养不良及肌肉减少症至关重要。