Background Data on the gastrointestinal (GI) manifestations of Pediatric Corona Virus Disease (COVID-19) are conflicting and the relationship between GI involvement and the severity of COVID-19 disease has not been evaluated. The objectives of this systematic review were to determine the GI manifestations of pediatric COVID-19 and to evaluate their role as risk factors for a severe clinical course. Methods : A systematic literature search was carried out in PubMed and Scopus for studies published before 31 December 2020 with information about the GI manifestations of pediatric COVID-19. Patients with a severe and nonsevere clinical course were compared using the inverse variance heterogeneity model and odds ratio (OR) as the effect size. A sensitivity analysis was performed if the heterogeneity was high among studies. Results A total of 811 studies were identified through a systematic search of which 55 studies (4369 patients) were included in this systematic review. The commonest GI symptoms were diarrhea—19.08% [95% confidence interval (CI) 10.6–28.2], nausea/vomiting 19.7% (95% CI 7.8–33.2) and abdominal pain 20.3% (95% CI 3.7–40.4). The presence of diarrhea was significantly associated with a severe clinical course with a pooled OR of 3.97 (95% CI 1.80–8.73; p < 0.01). Abdominal pain and nausea/vomiting were not associated with disease severity. Conclusions Diarrhea, nausea/vomiting or abdominal pain are present in nearly one-fifth of all children with COVID-19. The presence of diarrhea portends a severe clinical course.

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小儿冠状病毒病的胃肠道表现及其与严重临床病程的关系：系统评价和荟萃分析

背景 关于小儿冠状病毒病 (COVID-19) 胃肠道 (GI) 表现的数据相互矛盾，尚未评估胃肠道受累与 COVID-19 疾病严重程度之间的关系。本系统评价的目的是确定儿科 COVID-19 的 GI 表现，并评估其作为严重临床病程危险因素的作用。方法：在 PubMed 和 Scopus 中对 2020 年 12 月 31 日之前发表的关于儿科 COVID-19 胃肠道表现信息的研究进行了系统的文献检索。使用逆方差异质性模型和优势比 (OR) 作为效应大小来比较具有严重和非严重临床过程的患者。如果研究之间的异质性很高，则进行敏感性分析。结果 通过系统检索共确定了 811 项研究，其中 55 项研究（4369 名患者）被纳入本系统评价。最常见的胃肠道症状是腹泻——19.08% [95% 置信区间 (CI) 10.6–28.2]、恶心/呕吐 19.7% (95% CI 7.8–33.2) 和腹痛 20.3% (95% CI 3.7–40.4)。腹泻的存在与严重的临床病程显着相关，合并 OR 为 3.97（95% CI 1.80-8.73；p < 0.01）。腹痛和恶心/呕吐与疾病严重程度无关。结论 近五分之一的 COVID-19 儿童存在腹泻、恶心/呕吐或腹痛。腹泻的存在预示着严重的临床过程。最常见的胃肠道症状是腹泻——19.08% [95% 置信区间 (CI) 10.6–28.2]、恶心/呕吐 19.7% (95% CI 7.8–33.2) 和腹痛 20.3% (95% CI 3.7–40.4)。腹泻的存在与严重的临床病程显着相关，合并 OR 为 3.97（95% CI 1.80-8.73；p < 0.01）。腹痛和恶心/呕吐与疾病严重程度无关。结论 近五分之一的 COVID-19 儿童存在腹泻、恶心/呕吐或腹痛。腹泻的存在预示着严重的临床过程。最常见的胃肠道症状是腹泻——19.08% [95% 置信区间 (CI) 10.6–28.2]、恶心/呕吐 19.7% (95% CI 7.8–33.2) 和腹痛 20.3% (95% CI 3.7–40.4)。腹泻的存在与严重的临床病程显着相关，合并 OR 为 3.97（95% CI 1.80-8.73；p < 0.01）。腹痛和恶心/呕吐与疾病严重程度无关。结论 近五分之一的 COVID-19 儿童存在腹泻、恶心/呕吐或腹痛。腹泻的存在预示着严重的临床过程。80–8.73；p＜0.01)。腹痛和恶心/呕吐与疾病严重程度无关。结论 近五分之一的 COVID-19 儿童存在腹泻、恶心/呕吐或腹痛。腹泻的存在预示着严重的临床过程。80–8.73；p＜0.01)。腹痛和恶心/呕吐与疾病严重程度无关。结论 近五分之一的 COVID-19 儿童存在腹泻、恶心/呕吐或腹痛。腹泻的存在预示着严重的临床过程。