COVID-19 Linked to Greater Risk of GI Tract Symptoms, Disorders in Children

Yong Chen, PhD

Credit: University of Pennsylvania

COVID-19 is associated with an increased risk of gastrointestinal (GI) tract symptoms and diseases during the postacute and chronic phases of infection in pediatric patients, according to findings from a recent study.¹

The cohort study of more than 1.5 million children and adolescents from 29 US healthcare institutions found a significant association between documented SARS-CoV-2 infection and increased risks of abdominal pain, bloating, constipation, and gastroesophageal reflux disease (GERD) extending into the chronic phase, underscoring the importance of considering COVID-19 history when evaluating persistent GI tract symptoms in this population.¹

According to the US Centers for Disease Control and Prevention, while COVID-19 most often causes respiratory symptoms, it can also affect other parts of the body.² In the context of GI symptoms, this can include a lack of appetite, nausea, vomiting, diarrhea, and abdominal pain. Although an increased risk of GI tract symptoms and disorders has been observed among adults with COVID, less is known about how the GI tract may be affected in pediatric patients.¹

“As the data regarding the long-term outcomes of SARS-CoV-2 in the GI tract among children are limited, it is unclear whether children have the same risks of GI tract conditions during the postacute phase of COVID-19 as has been seen with adults,” Yong Chen, PhD, a professor of biostatistics in the department of biostatistics, epidemiology, and informatics at the University of Pennsylvania Perelman School of Medicine, and colleagues wrote.¹

To address this gap in research, investigators conducted a retrospective cohort study of pediatric patients ≤ 18 years of age seen at 29 institutions between March 1, 2020, and September 1, 2023, with a cohort entry date cutoff of March 6, 2023, to ensure each individual had ≥ 6 months of follow-up. Patients with ≥ 1 documented SARS-CoV-2 infection, including positive polymerase chain reaction test results, serological tests, antigen tests, diagnosed COVID-19, or postacute sequelae of SARS-CoV-2 (PASC), were included in the COVID-19-positive cohort, while those with ≥ 1 negative test result and no documented SARS-CoV-2 infection comprised the COVID-19-negative cohort.¹

GI tract symptoms and disorders were identified using diagnostic codes in the postacute and chronic phases following documented SARS-CoV-2 infection. Specifically, investigators explored abdominal pain, bloating, constipation, diarrhea, nausea, vomiting, functional dyspepsia, GERD, and irritable bowel syndrome (IBS) during the follow-up period, defined as 28-729 days after the cohort entry date.¹

In total, the study included 1,576,933 pediatric patients with a mean age of 7.3 (Standard deviation [SD], 5.7) years, the majority of whom were male (52.0%) and non-Hispanic White (42.6%). Among the cohort, 413,455 patients had documented SARS-CoV-2 infection and 1,163,478 did not.¹

Upon analysis, the COVID-19-positive cohort exhibited increased risks for a composite of any of the GI tract signs or symptoms (8.24% vs 6.45%; adjusted risk ratio [ARR], 1.26; 95% CI, 1.24-1.28), any of the GI tract disorders (1.27% vs 1.12%; ARR, 1.19; 95% CI, 1.15-1.24), and any visits related to the GI tract (8.64% vs 6.85%; ARR, 1.25; 95% CI, 1.24-1.27).¹

Investigators noted patients with a documented SARS-CoV-2 infection had an increased risk of developing ≥ 1 GI tract symptom or disorder in both the postacute (8.64% vs 6.85%; ARR, 1.25; 95% CI, 1.24-1.27) and chronic (12.60% vs 9.47%; ARR, 1.28; 95% CI, 1.26-1.30) phases compared with patients without a documented infection.¹

Specifically, in the postacute phase, the COVID-19-positive cohort exhibited increased risks for a composite of any of the GI tract signs or symptoms (8.24% vs 6.45%; ARR, 1.26; 95% CI, 1.24-1.28) and any of the GI tract disorders (1.27% vs 1.12%; ARR, 1.19; 95% CI, 1.15-1.24).¹

Similarly, in the chronic phase, COVID-19-positive patients exhibited increased risks of a composite of any of the GI tract signs or symptoms (12.19% vs 9.13%; ARR, 1.26; 95% CI, 1.22-1.30) and any of the GI tract disorders (1.82% vs 1.40%; ARR, 1.28; 95% CI, 1.26-1.30).¹

“These findings underscore the potential for prolonged GI tract issues in pediatric COVID-19 cases, suggesting that a history of COVID-19 should be considered in evaluating persistent GI tract symptoms,” investigators concluded.¹ “They highlight the importance of ongoing monitoring for PASC outcomes in children and call for further research to understand underlying mechanisms and improve targeted care.”

References

1. ^{Zhang D, Stein R, Lu Y, et al. Pediatric Gastrointestinal Tract Outcomes During the Postacute Phase of COVID-19. JAMA Netw Open. doi:10.1001/jamanetworkopen.2024.58366}
2. ^{US Centers for Disease Control and Prevention. About COVID-19. Accessed February 7, 2025. https://www.cdc.gov/covid/index.html}