Pediatric Gastrointestinal Tract Outcomes During the Postacute Phase of COVID-19
Authors: Zhang Dazheng , Stein Ronen , Lu Yiwen , Zhou Ting , Lei Yuqing , Li Lu , Chen Jiajie , Arnold Jonathan , Becich Michael J. , Chrischilles Elizabeth A. , Chuang Cynthia H. , Christakis Dimitri A. , Fort Daniel , Geary Carol R. , Hornig Mady , Kaushal Rainu , Liebovitz David M. , Mosa Abu S. M. , Morizono Hiroki , Mirhaji Parsa , Dotson Jennifer L. , Pulgarin Claudia , Sills Marion R. , Suresh Srinivasan , Williams David A. , Baldassano Robert N. , Forrest Christopher B. , Chen Yong ,   Researching COVID to Enhance Recovery (RECOVER) Initiative, Diaz Iván , Kenney Rachel , Divers Jasmin , Thorpe Lorna , Bello Olalekan , Chen Yu , Lamendola-Essel Michelle , Mandel Hannah , Truong Jennifer , Wuller Shannon W. , Deakyne Davies Sara J. , Rao Suchitra , Bailey L. Charles , Forrest Christopher B. , Kim Dongkyu , Pajor Nathan M , Sengupt Soumitra , Jones W. Schuyler , Kelleher Kelly J , Huang Yungui , Bunnell H Timothy , Duque Maurice , Ladino Nathalia , Fort Daniel , Chuang Cynthia H. , Ranade Daksha , Schroeder Alan , Kim Susan , Bian Jiang , Chrischilles Elizabeth A. , Williams David A. , Mosa Abu Saleh Mohammad , Reynolds Geary Carol , Becich Michael J. , Arnold Jonathan , Senathirajah Yalini , Ostasiewski Brian , Downs Stephen M. , Kaushal Rainu , Campion Thomas R , Soby Selvin , Jhaveri Ravi J , Nandagopal Jyothi Priya Alekapatti , Kieler Curtis , Taylor Bradley W , Stoddard Alexander , Shaker Reza , Blecker Saul , Sills Marion R. , Christakis Dimitri A . , Morse Keith E. , Pletcher Mark J. , Liu Mei , Svoboda Jim , Cappella Nickie , Wei Wei-Qi 
Published: February 2025

Importance

The profile of gastrointestinal (GI) tract outcomes associated with the postacute and chronic phases of COVID-19 in children and adolescents remains unclear.

Objective

To investigate the risks of GI tract symptoms and disorders during the postacute (28-179 days after documented SARS-CoV-2 infection) and the chronic (180-729 days after documented SARS-CoV-2 infection) phases of COVID-19 in the pediatric population.

Design, Setting, and Participants

This retrospective cohort study was performed from March 1, 2020, to September 1, 2023, at 29 US health care institutions. Participants included pediatric patients 18 years or younger with at least 6 months of follow-up. Data analysis was conducted from November 1, 2023, to February 29, 2024.

Exposures

Presence or absence of documented SARS-CoV-2 infection. Documented SARS-CoV-2 infection included positive results of polymerase chain reaction analysis, serological tests, or antigen tests for SARS-CoV-2 or diagnosis codes for COVID-19 and postacute sequelae of SARS-CoV-2.

Main Outcomes and Measures

GI tract symptoms and disorders were identified by diagnostic codes in the postacute and chronic phases following documented SARS-CoV-2 infection. The adjusted risk ratios (ARRs) and 95% CI were determined using a stratified Poisson regression model, with strata computed based on the propensity score.

Results

The cohort consisted of 1 576 933 pediatric patients (mean [SD] age, 7.3 [5.7] years; 820 315 [52.0%] male). Of these, 413 455 patients had documented SARS-CoV-2 infection and 1 163 478 did not; 157 800 (13.6%) of those without documented SARS-CoV-2 infection had a complex chronic condition per the Pediatric Medical Complexity Algorithm. Patients with a documented SARS-CoV-2 infection had an increased risk of developing at least 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. Specifically, the risk of abdominal pain was higher in COVID-19–positive patients during the postacute (2.54% vs 2.06%; ARR, 1.14; 95% CI, 1.11-1.17) and chronic (4.57% vs 3.40%; ARR, 1.24; 95% CI, 1.22-1.27) phases.

Conclusions and Relevance

In this cohort study, the increased risk of GI tract symptoms and disorders was associated with the documented SARS-CoV-2 infection in children or adolescents during the postacute or chronic phase. Clinicians should note that lingering GI tract symptoms may be more common in children after documented SARS-CoV-2 infection than in those without documented infection.