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