COVID-19 in children with chronic digestive system pathology

COVID-19 in children is characterized by a predominance of mild and asymptomatic forms, along with frequent gastrointestinal symptoms. It is known that comorbid conditions are a risk factor for severe COVID-19 in children; however, the course of SARS-CoV-2 infection in children with chronic digestive system diseases remains under-researched. Objective. To identify the specific characteristics of COVID-19 in children with chronic digestive system diseases, assess risk factors for severe COVID-19, and evaluate the impact of immunosuppressive therapy on COVID-19 outcomes. Materials and Methods. A single-center cohort retrospective and prospective non-randomized study was conducted, including 74 patients with COVID-19 and chronic digestive system diseases and a control group of 30 patients with COVID-19 without comorbidities, all hospitalized in the infectious disease department of the Russian Children’s Clinical Hospital, Moscow, in 2022 and 2023. Results. Сhildren with underlying digestive system diseases were not at a higher risk of severe COVID-19 compared to the control group. Severe, uncontrolled somatic disease and the presence of two or more comorbidities were risk factors for complicated SARS-CoV-2 infection. The duration of detectable SARS-CoV-2 RNA in the study group was nine days. Conclusion. Patients with chronic digestive system diseases, including those receiving immunosuppressive therapy, do not appear to be at higher risk for severe or unfavorable COVID-19 outcomes; however, prolonged SARS-CoV-2 RNA shedding was observed. Risk factors for severe COVID-19 include the presence of two or more comorbidities and severe somatic disease.

COVID-19, SARS-CoV-2, coronavirus infection, children, gastroenterology, digestive system diseases, somatic pathology, comorbid conditions

1. Lan J., Ge J., Yu J. et al. Structure of the SARS-CoV-2 spike receptor-binding domain bound to the ACE2 receptor. Nature. 2020;581(7807):215-220. doi: 10.1038/s41586-020-2180-5.

2. Kharitonova L.A., Osmanov I.M., Ploskireva A.A., Solodovnikova O.N., Milova Yu.E. Digestionaldiseasesin Covid-19 in children. Experimental and Clinical Gastroenterology. 2021;1(1):53-66. (In Russ.) doi: 10.31146/1682-8658-ecg-185-1-53-66.@@ Харитонова Л.А., Османов И.М., Плоскирева А.А., Солодовникова О.Н., Милова Ю.Е. Поражения органов пищеварения при Covid-19 у детей. Экспериментальная и клиническая гастроэнтерология. 2021;1(1):53-66. doi: 10.31146/1682-8658-ecg-185-1-53-66.

3. Yakovenko E.P., Iakovenko A.V., Ivanov A.N., Agafonova N.A. Pathology of the digestive tract and liver with COVID-19. Experimental and Clinical Gastroenterology. 2020;176(4): 19-23. (In Russ.) doi: 10.31146/1682-8658-ecg-176-4-19-23.@@ Яковенко Э.П., Яковенко А.В., Иванов А.Н., Агафонова Н.А. Патология пищеварительного тракта и печени при COVID-19. Экспериментальная и клиническая гастроэнтерология. 2020;176(4): 19-23. doi: 10.31146/1682-8658-ecg-176-4-19-23.

4. Qi F., Qian S., Zhang S., Zhang Z. Single cell RNA sequencing of 13 human tissues identify cell types and receptors of human coronaviruses. Biochem Biophys Res Commun. 2020;526(1):135-140. doi: 10.1016/j.bbrc.2020.03.044.

5. Zou X., Chen K., Zou J., Han P., Hao J., Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020;14(2):185-192. doi: 10.1007/s11684-020-0754-0.

6. Mao R., Qiu Y., He J.S. et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis [published correction appears in Lancet Gastroenterol Hepatol. 2020 Jul;5(7): e6. doi: 10.1016/S2468-1253(20)30160-6]. Lancet Gastroenterol Hepatol. 2020;5(7):667-678. doi: 10.1016/S2468-1253(20)30126-6.

7. Dong Z.Y., Xiang B.J., Jiang M., Sun M.J., Dai C. The Prevalence of Gastrointestinal Symptoms, Abnormal Liver Function, Digestive System Disease and Liver Disease in COVID-19 Infection: A Systematic Review and Meta-Analysis. J Clin Gastroenterol. 2021;55(1):67-76. doi: 10.1097/MCG.0000000000001424.

8. Clinical Protocol for the Treatment of Children with the New Coronavirus Infection (COVID-19) Undergoing Inpatient Treatment in Medical Organizations of the State Health System of the City of Moscow / Edited by A.I. Khripun. Moscow. GBU «NIIOSMM DZM», 2022. 92 p. (In Russ.) Available at: https://niioz.ru/upload/iblock/0d4/0d4da6c53a332fb4a594b5fd52bae41b.pdf (accessed: 29.10.2024)@@ Клинический протокол лечения детей с новой коронавирусной инфекцией (COVID-19), находящихся на стационарном лечении в медицинских организациях государственной системы здравоохранения города Москвы / Под редакцией А.И. Хрипуна. - М.: ГБУ «НИИОЗММ ДЗМ», 2022-92 с. URL: https://niioz.ru/upload/iblock/0d4/0d4da6c53a332fb4a594b5fd52bae41b.pdf (дата обращения: 29.10.2024).

9. D’Amico F., Danese S., Peyrin-Biroulet L. Systematic Review on Inflammatory Bowel Disease Patients With Coronavirus Disease 2019: It Is Time to Take Stock. Clin Gastroenterol Hepatol. 2020;18(12):2689-2700. doi: 10.1016/j.cgh.2020.08.003.

10. Singh S., Khan A. Clinical Characteristics and Outcomes of Coronavirus Disease 2019 Among Patients With Preexisting Liver Disease in the United States: A Multicenter Research Network Study. Gastroenterology. 2020;159(2):768-771.e3. doi: 10.1053/j.gastro.2020.04.064.

11. Drapkina O.M., Maev I.V., Bakulin I.G. et al.Interim guidelines: & quot; Diseases of the digestive organs in the context of a new coronavirus infection pandemic (COVID-19) & quot.Russian Journal of Preventive Medicine. 2020;23(3-2):120-152. (In Russ.) doi: 10.17116/profmed202023032120.@@ Драпкина О.М., Маев И.В., Бакулин И.Г. и др. Временные методические рекомендации: «Болезни органов пищеварения в условиях пандемии новой коронавирусной инфекции (COVID-19)». Профилактическая медицина. 2020;23(3-2):120-152. doi: 10.17116/profmed202023032120.

12. Ludvigsson J.F., Axelrad J., Halfvarson J. et al. Inflammatory bowel disease and risk of severe COVID-19: A nationwide population-based cohort study in Sweden. United European Gastroenterol J. 2021;9(2):177-192. doi: 10.1002/ueg2.12049.

13. Grinevich V.B., Kravchuk Yu.A., Ped V.I. et al. Management of patients with digestive diseases during the COVID-19 pandemic. Clinical Practice Guidelines by the Russian scienti c medical society of internal medicine (RSMSIM) and the Gastroenterological Scienti c Society of Russia (2nd edition). Experimental and Clinical Gastroenterology. 2021;(3):5-82. (In Russ.) doi: 10.31146/1682-8658-ecg-187-3-5-82.@@ Гриневич В.Б., Кравчук Ю.А., Педь В.И. и др. Ведение пациентов с заболеваниями органов пищеварения в период пандемии COVID-19.Клинические рекомендации Российского научного медицинского общества терапевтов и Научного общества гастроэнтерологов России (2-е издание). Экспериментальная и клиническая гастроэнтерология. 2021;(3):5-82. doi: 10.31146/1682-8658-ecg-187-3-5-82.

14. Cheung K.S., Hung I.F.N., Chan P.P.Y. et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis. Gastroenterology. 2020;159(1):81-95. doi: 10.1053/j.gastro.2020.03.065.

15. Choi J.H., Choi S.H., Yun K.W. Risk Factors for Severe COVID-19 in Children: A Systematic Review and Meta-Analysis. J Korean Med Sci. 2022;37(5): e35. Published 2022 Feb 7. doi: 10.3346/jkms.2022.37.e35.

16. Brenner E.J., Ungaro R.C., Gearry R.B. et al. Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry. Gastroenterology. 2020;159(2):481-491.e3. doi: 10.1053/j.gastro.2020.05.032.

17. El Ouali S., Philpott J., Vargo J., Regueiro M. COVID-19 in patients with IBD and pancreaticobiliary disorders. Cleve Clin J Med. Published online August 27, 2020. doi: 10.3949/ccjm.87a.ccc062.

18. Amiot A., Rahier J.F., Baert F. et al. The Impact of COVID-19 on Patients with IBD in a Prospective European Cohort Study. J Crohns Colitis. 2023;17(1):37-48. doi: 10.1093/ecco-jcc/jjac091.

19. Magro F., Nuzzo A., Abreu C. et al. COVID-19 in gastroenterology: Where are we now? Current evidence on the impact of COVID-19 in gastroenterology. United European Gastroenterol J. 2021;9(7):750-765. doi: 10.1002/ueg2.12115.

20. Turner D., Huang Y., Martín-de-Carpi J. et al. Corona Virus Disease 2019 and Paediatric Inflammatory Bowel Diseases: Global Experience and Provisional Guidance (March 2020) from the Paediatric IBD Porto Group of European Society of Paediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2020;70(6):727-733. doi: 10.1097/MPG.0000000000002729.

21. Efe C., Dhanasekaran R., Lammert C. et al. Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An International Multicenter Study. Hepatology. 2021;73(6):2099-2109. doi: 10.1002/hep.31797.

22. Uchaikin V.F., Talalaev A.G., Novikova A.V., Levitsky M.V. The Role of Rotaviruses in Chronic Gastroenterological Pathology in Children. Pediatric Infections. 2003. No. 1. (In Russ.) Available at: https://cyberleninka.ru/article/n/rol-rotavirusov-v-hronicheskoy-gastroenterologicheskoy-patologii-u-detey (accessed: 29.10.2024) @@ Учайкин В.Ф., Талалаев А.Г., Новикова А.В., Левитский М.В. Роль ротавирусов в хронической гастроэнтерологической патологии у детей. Детские инфекции. 2003. № 1. URL: https://cyberleninka.ru/article/n/rol-rotavirusov-v-hronicheskoy-gastroenterologicheskoy-patologii-u-detey (дата обращения: 29.10.2024).