374 Gastrointestinal manifestations, investigations, and treatments of ‘Long COVID’ in children and young people: a systematic review and meta-analysis
Bibliographic record
Abstract
Objectives Long Covid in children and young people (CYP) describes a range of symptoms persisting 4–12 weeks after an acute COVID-19 infection (Venkatesan 2021). Gastrointestinal (GI) manifestations of long COVID include diarrhoea, nausea, vomiting, abdominal pain, anorexia, constipation and weight loss. Data on the prevalence of these symptoms and the investigations and treatments used in CYP with Long COVID is unexplored, hence clinical guidance remains uncertain. The primary outcome measure of this systematic review is the pooled prevalence of GI manifestations in Long Covid in CYP. Additionally, the investigations and treatments used in CYP will be evaluated in a narrative review. Methods In March 2022, we conducted a systematic literature review to evaluate prevalence of GI symptoms in Long COVID and published approach to investigations and treatment in long COVID amongst CYP. Original data from prospective and retrospective studies were retrieved from 9 databases and from unpublished grey literature. Studies not written in English, reporting PIMS-TS/MIS-C patients, Long COVID patients not meeting the NICE guidelines or not reporting CYP were excluded. Overall, 19 studies met the inclusion criteria: 10 cohort studies, 5 case reports and 4 cross sectional studies. Results We assessed study quality using the Newcastle-Ottawa scale. 2 studies were classified as having a low risk of bias, 15 moderate and 5 high. Abdominal pain was the most reported GI symptom in CYP with Long COVID (9.03%), followed by nausea (2.85%) and constipation (2.29%). Table 1 demonstrates the meta-analysis of 14 students, calculating the estimated pooled prevalence of GI symptoms in CYP with Long covid was 18% (95% CI 0–63.5%), with the most prevalent manifestation being diarrhoea (5.39%, 95% CI 0–13.8%). The efficacy of investigations and treatments for these complications were described in 5 case reports. Four treatments and 19 investigations were trialed with inconclusive results. Conclusions Meta-analysis suggests that GI manifestations are significant symptoms, present in almost a fifth of CYP with Long COVID, but are not highly prevalent in this population. This comprehensive assessment of published investigations and treatments will increase awareness and assist the development of clinical guidelines in this field. However, the evidence base was limited by a paucity of homogenous studies. Considering the debilitating ongoing effects caused by these symptoms on quality of life of CYP, further high-quality prospective studies, including those evaluating treatments and investigations, are urgently needed to optimize management. Reference Venkatesan P. ‘NICE guideline on long COVID’, Lancet Respir Med 2021;9:129.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.033 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.027 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".