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Systematic review
Gastrointestinal manifestations of COVID-19 in children: a systematic review and meta-analysis
  1. Anthony K Akobeng1,2,
  2. Ciaran Grafton-Clarke3,
  3. Ibtihal Abdelgadir2,4,
  4. Erica Twum-Barimah5,
  5. Morris Gordon6
  1. 1 Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha, Qatar
  2. 2 Weill Cornell Medicine, Doha, Qatar
  3. 3 University of Leicester, Leicester, Leicestershire, UK
  4. 4 Pediatric Emergency Medicine, Sidra Medicine, Doha, Qatar
  5. 5 Paediatrics, Milton Keynes University Hospital, Milton Keynes, Milton Keynes, UK
  6. 6 University of Central Lancashire, Preston, Lancashire, UK
  1. Correspondence to Professor Anthony K Akobeng, Sidra Medicine, Doha, Qatar; aakobeng{at}


Objectives To summarise the published evidence on the gastrointestinal manifestations of COVID-19 in children and to determine the prevalence of gastrointestinal symptoms.

Methods In this systematic review and meta-analysis, we searched PubMed, Embase, CINAHL and the WHO’s database of publications on novel coronavirus. We included English language studies that had described original demographic and clinical characteristics of children diagnosed with COVID-19 and reported on the presence or absence of gastrointestinal symptoms. Meta-analysis was conducted using the random-effects model. The pooled prevalence of gastrointestinal symptoms was expressed as proportion and 95% CI.

Results The search identified 269 citations. Thirteen studies (nine case series and four case reports) comprising data for 284 patients were included. Overall, we rated four studies as having a low risk of bias, eight studies as moderate and one study as high risk of bias. In a meta-analysis of nine studies, comprising 280 patients, the pooled prevalence of all gastrointestinal symptoms was 22.8% (95% CI 13.1% to 35.2%; I2=54%). Diarrhoea was the most commonly reported gastrointestinal symptom followed by vomiting and abdominal pain.

Conclusions Nearly a quarter of children with COVID-19 have gastrointestinal symptoms. It is important for clinicians to be aware of the gastrointestinal manifestation of COVID-19.

PROSPERO registration number CRD42020177569.

  • abdominal pain
  • diarrhoea
  • infectious disease

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  • Contributors AA had the idea for the review. CG-C, IA and MG selected studies for inclusion and abstracted data. AKA wrote the first draft. MG, CG-C, IA, ET-B and AKA interpreted data and critically revised the paper for important intellectual content. All authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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