Children, teens face 25% higher risk for adverse GI outcomes after COVID-19 infection
Key takeaways:
- Children with long COVID had increased risk for almost all the GI symptoms and diseases the researchers examined.
- A history of COVID-19 should be considered among children with persistent GI symptoms.
Children and adolescents with documented postacute COVID-19 syndrome experienced increased risk for gastrointestinal symptoms and disorders, according to a study published in JAMA Open Network.
Previous research shows that adults with long COVID experienced increased risk for GI symptoms and disorders, including abdominal pain, diarrhea, constipation, vomiting, bloating, irritable bowel syndrome and GERD, during the first year after infection.
However, “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,” Dazheng Zhang, MS, PhD student in the department of biostatistics, epidemiology and informatics at Perelman School of Medicine at the University of Pennsylvania and research team member at the Center for Health AI and Synthesis of Evidence, and colleagues wrote.
This inspired the researchers to conduct a retrospective cohort study to evaluate how the postacute (28-179 days after) and chronic phases (180-729 days after) of COVID-19 illness impact risk for GI symptoms and disorders in the pediatric population, specifically looking at abdominal pain, bloating, constipation, diarrhea, nausea, vomiting, functional dyspepsia, GERD and IBS.
The study included 1.58 million patients aged 18 years or younger (mean age, 7.3 years; standard deviation, 5.7 years; 52% male; 42.6% non-Hispanic white) at 29 U.S. children’s hospitals and health institutions from March 2020 to September 2023 who had at least 6 months of follow-up.
Of the total cohort, the researchers found that 413,455 patients had documented SARS-CoV-2 infection.
Overall, those with a prior COVID-19 infection appeared more likely than those without to have any visits related to the GI tract in the postacute (8.64% vs. 6.85%; adjusted RR = 1.25; 95% CI, 1.24-1.27) — representing a 25% increased probability — and chronic (12.6% vs. 9.47%; aRR = 1.28; 95% CI, 1.26-1.3) phases.
Specifically, compared with children and adolescents without documented infection, patients with long COVID had increased risk for:
- abdominal pain (postacute: aRR = 1.14; 95% CI, 1.11-1.17; chronic: aRR = 1.24; 95% CI, 1.22-1.27),
- bloating (postacute: aRR = 1.27; 95% CI, 1.18-1.37; chronic: aRR = 1.3; 95% CI, 1.22-1.38),
- constipation (postacute: aRR = 1.2; 95% CI, 1.17-1.23; chronic: aRR = 1.23; 95% CI, 1.21-1.25),
- diarrhea (postacute: aRR = 1.4; 95% CI, 1.36-1.43; chronic: aRR = 1.48; 95% CI, 1.45-1.51),
- nausea (postacute: aRR =1.27; 95% CI, 1.21-1.33; chronic: aRR = 1.38; 95% CI, 1.33-1.43),
- vomiting (postacute: aRR = 1.33; 95% CI, 1.3-1.36; chronic: aRR = 1.4; 95% CI, 1.37-1.42),
- GERD (postacute: aRR = 1.19; 95% CI, 1.15-1.24; chronic: aRR = 1.28; 95% CI, 1.24-1.33), and
- IBS only in the chronic phase (aRR = 1.09; 95% CI, 1-1.18).
Finally, subgroup analyses revealed that children aged younger than 5 years were at the greatest risk for adverse GI outcomes compared with other age groups.
“Our findings align with prior research indicating that COVID-19 elevates the risk of GI tract symptoms such as nausea, diarrhea, and disorders like functional dyspepsia,” Zhang and colleagues wrote. “Chronic GI tract symptoms following infections are well-documented in pediatric populations, often without a serious underlying cause.”
The researchers observed several limitations to this study, including potential misclassification of SARS-CoV-2 infection in the electronic health record and the study’s limited generalizability due to restricting the cohort to patients with regular access to pediatric academic centers.
“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,” the authors wrote.
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