Gastrointestinal disorders in post-COVID syndrome. Clinical guidelines

Summary Post- COVID syndrome refers to the long-term consequences of a new coronavirus infection COVID-19, which includes a set of symptoms that develop or persist after COVID-19. Symptoms of gastrointestinal disorders in post- COVID syndrome, due to chronic infl ammation, the consequences of organ damage, prolonged hospitalization, social isolation, and other causes, can be persistent and require a multidisciplinary approach. The presented clinical practice guidelines consider the main preventive and therapeutic and diagnostic approaches to the management of patients with gastroenterological manifestations of postCOVID syndrome. The Guidelines were approved by the 17th National Congress of Internal Medicine and the 25th Congress of Gastroenterological Scientifi c Society of Russia.

[Differential diagnosis of parapharyngeal abscess with multisystem inflammatory syndrome in children associated with COVID-19]

The pandemic of the new coronavirus infection (COVID-19) has identified new diagnostic and medical tasks before different doctors. As observations show, children have the flow of infection easier than adults. However, in some cases, COVID-19 in children proceeds extremely difficult, with fever and multisystem inflammation, possibly requiring treatment in the resuscitation department. In domestic practice, the term "Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19" is used to indicate the disease. Among the local symptoms of MIS are inflammations of the skin and mucous membranes, as well as various lymphadenopathy. The article presents the results of our clinic's observation of 205 patients with MIS for the period from May 2020 to May 2021. In some patients, the clinical manifestations of MIS-C required differential diagnosis with parapharyngeal abscesses (PPA). For this purpose, the children were consulted by an otorhinolaryngologist and a CT scan of the neck with contrast enhancement was performed. Despite the striking clinical manifestations similar to PPA, in no case was a pharyngeal abscess revealed. Both of these diseases are potentially fatal if treatment is not started on time, and therefore we believe that the awareness of otorhinolaryngologists about the manifestations of MIS-C will be useful in modern clinical practice.

Digestional diseases in Covid‑19 in children

The new coronavirus infection (COVID‑19) caused by the SARS-CoV‑2 coronavirus is rightfully recognized as a pandemic of the 21st century and poses a threat to the health of all human race. According to the World Health Organization, at October 4, 2020, were registered worldwide 34,804,348 confirmed cases of COVID‑19, including 1,030,738 deaths. According to currently available data, children accounted for 1 to 5% of patients diagnosed with COVID‑19 [4]. Children aged between 10–18 years dominated (45.9%), and patients first years of life accounted 26.1%. At the same time, over the period since the beginning of the pandemic, only a few fatal outcomes of the disease in children have been recorded in world statistics.

The high contagiousness of the SARS-CoV‑2 coronavirus, the ability for long-term replication, and tropism for the cells of the immune system provide the virus with the possibility of almost simultaneous multiple organ damage with the rapid development of complications of both the respiratory tract and other organs and systems.

The gastrointestinal tract is involved in this pathological process, representing one of the “shock organs”. In addition to common respiratory symptoms, some COVID‑19 patients experience dyspeptic disorders such as diarrhea, nausea, and vomiting. Anal swab samples from patients positive for COVID‑19, are positive for SARS-CoV‑2 nucleic acid, and SARS-CoV‑2 were isolated from stool samples from COVID‑19 patients. In addition, in both adults and children, there is a strong association between damage to the digestive system and SARS-CoV‑2 infection. This review summarizes the manifestations and potential mechanisms of gastrointestinal manifestations in COVID‑19 in children.

The aim of the work is a review of current data on the lesion of the gastrointestinal tract in children with COVID‑19 infection, and its impact on the management of patients with chronic diseases of the digestive tract.

Materials and methods of research. Was carried out the analysis of publications in PubMed, EMBASE and Web of Science systems in the period from December 2019 to June 2020, documenting the clinical course of COVID‑19 disease with gastrointestinal lesions. The following search terms are used: “COVID‑19”, “SARS-CoV‑2”, “coronavirus”, “SARS-CoV‑2 pandemic, epidemic”, “outbreak”, “diarrhea”, “gastrointestinal symptoms”, “stool”, “feces” without any language restrictions. The main source of information was full-text scientific publications of both, foreign and russian authors.

In addition, clinical cases of COVID‑19 were analyzed among patients of infectious departments of the Children’s Clinical Hospital named after Z. A. Bashlyaeva, Moscow. Clinical manifestations of the disease, data from laboratory and instrumental studies were evaluated. The most informative of them is given as a clinical example.