Pediatric Functional Abdominal Pain Disorders following COVID-19

Abstract

Background: Functional abdominal pain disorders (FAPD) are a group of functional gastrointestinal disorders with multifactorial etiology and are subclassified using Rome IV criteria into a series of clinically distinct entities represented by irritable bowel syndrome, functional dyspepsia, abdominal migraine and functional abdominal pain that is not otherwise specified. Digestive functional disorders associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may be mediated by the involvement of complex pathogenic mechanisms, which have been under investigation in children since the beginning of the coronavirus disease pandemic (COVID-19). Methods: In this retrospective, observational descriptive and analytical study, we investigated the presence of chronical functional abdominal pain in preschool children (4–6 years old) from the south-west of Romania in the pre-pandemic (18 cases) and COVID-19 pandemic period (34 cases), as well as the association with the COVID-19 positive and COVID-19 negative statuses, gender, environment origin, and viral infection-associated symptoms. Age-specific Rome IV criteria were used to diagnose functional abdominal pain. We performed an integrated statistical analysis of the results utilizing an electronic database in which we compared the data in order to assess the impact of COVID-19 on the clinical-epidemiological parameters analyzed. Results: In the pre-pandemic group, irritable bowel syndrome predominated (77.8%), followed by functional dyspepsia (22.2%), the other types of functional abdominal pain being absent, while for the pandemic group, irritable bowel syndrome was the most common (79.4%), followed by abdominal migraine (11.8%), abdominal dyspepsia (5.9%) and functional abdominal pain not otherwise specified (2.9%). We found a female/male ratio difference of 0.84 and an urban/rural ratio of 1.83 in favor of the pandemic group. These discrepancies were mainly caused by the differences between the COVID-19 positive and negative pandemic groups, where we observed statistical association of the positive pandemic group with IBS and urban environment, and a tendency of FAPDs diagnostic mainly with males. The predominant symptoms associated with COVID-19 positive cases were digestive (60.9%) or respiratory (39.1%). Conclusions: Our study demonstrates viral-mediated sensitivity of the gastrointestinal tract in preschool children, considering different clinical-epidemiological profiles related to the prevalence of FAPD and according to gender and environment origin, while the contribution of the pandemic context remains to be demonstrated in larger studies

A systematic review of the prevalence of persistent gastrointestinal symptoms and incidence of new gastrointestinal illness after acute SARS-CoV-2 infection

“…Studies varied in how they defined COVID-19 cases. Sixteen studies included only participants with a positive reverse transcription polymerase chain reaction test (RT-PCR) for SARS-CoV-2 32, [41][42][43][44][45][46][47][48][49][50][51][52][53][54]56 . Three studies included participants who tested positive via an unspecified diagnostic method 30,33,55 .…”

“…The studies also varied in their clinical settings and ascertainment of gastrointestinal symptoms. Nine studies were conducted in patients who were hospitalised with COVID-19, discharged, and followed-up in the community [33][34][35][41][42][43][44][45]56 , twelve studies involved both hospitalised and community-managed cases 8,30,32,36,37,40,[46][47][48][49][50]55 , five studies involved community cases that did not require hospital admission 38,39,[51][52][53] and two studies did not specify the setting of recruitment 31,54 .…”

“…One study used EHRs to identify gastrointestinal endpoints based on clinical codes 8 . Six studies involved an in-person clinical assessment by a healthcare professional [33][34][35]41,43,44 . One study involved both a questionnaire and clinical assessment with a healthcare professional 48 .…”

“…Four studies report the incidence of new gastrointestinal disease following previous SARS-CoV-2 infection 43,44,50,54 . No studies reported the incidence of gastrointestinal infection following acute COVID-19.…”

“…No studies reported the incidence of gastrointestinal infection following acute COVID-19. Stepan et al found that children who visited the emergency department with abdominal pain, and tested positive for SARS-CoV-2 either six months before or three months after, had a higher incidence of irritable bowel syndrome (IBS) than those who tested negative (91.3% vs. 54.5%, p = 0.044) 44 .…”