Coronavirus Disease (COVID-19) and the Gastrointestinal System in Children

Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV2), though primarily a respiratory pathogen, also involves the gastrointestinal tract. Similar to the respiratory mucosa, angiotensin converting enzyme-2 (ACE-2) receptor and transmembrane serine protease 2 (TMPRSS2) co-express in the gastrointestinal tract, which facilitates viral entry into the tissue. Less than 10% of children with infection develop diarrhea and vomiting. Prolonged RT PCR positivity in the stool has raised the possibility of feco-oral transmission. Elevated transaminases are common, especially in those with severe coronavirus disease (COVID-19). Children with inflammatory bowel disease and post liver transplant patients do not have an increased risk of disease, and should remain on medications they are already on. Children with chronic liver disease should continue their medications as usual. All elective procedures like endoscopy should be postponed.