Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 3;8(2):e2458366.
doi: 10.1001/jamanetworkopen.2024.58366.

Pediatric Gastrointestinal Tract Outcomes During the Postacute Phase of COVID-19

Dazheng Zhang  1   2 , Ronen Stein  3   4 , Yiwen Lu  1   5 , Ting Zhou  1   2 , Yuqing Lei  1   2 , Lu Li  1   5 , Jiajie Chen  1   2 , Jonathan Arnold  6 , Michael J Becich  7 , Elizabeth A Chrischilles  8 , Cynthia H Chuang  9 , Dimitri A Christakis  10 , Daniel Fort  11 , Carol R Geary  12 , Mady Hornig  13 , Rainu Kaushal  14 , David M Liebovitz  15 , Abu S M Mosa  16 , Hiroki Morizono  17 , Parsa Mirhaji  18 , Jennifer L Dotson  19 , Claudia Pulgarin  20 , Marion R Sills  21   22 , Srinivasan Suresh  23   24   25 , David A Williams  26 , Robert N Baldassano  3   4 , Christopher B Forrest  27 , Yong Chen  1   2   5   28   29   30 ; Researching COVID to Enhance Recovery (RECOVER) Initiative
Collaborators, Affiliations

Pediatric Gastrointestinal Tract Outcomes During the Postacute Phase of COVID-19

Dazheng Zhang et al. JAMA Netw Open. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Arnold reported receiving grant funding from Amgen Inc and Pfizer Inc outside the submitted work. Dr Chuang reported receiving grant funding from Patient-Centered Outcomes Research Institute (PCORI) during the conduct of the study. Dr Reynolds Geary reported receiving grant funding from the National Institutes of Health (NIH) and PCORI during the conduct of the study. Dr Kaushal reported receiving grant funding from the NIH during the conduct of the study. Dr Dotson reported receiving grant funding from Pfizer Inc outside the submitted work. Dr Sills reported receiving grant funding from the NIH during the conduct of the study. Dr Williams reported receiving grant funding from the NIH and PCORI during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Study Cohort Selection for COVID-19–Positive and COVID-19–Negative Groups
Patients were identified with (positive) or without (negative) documented SARS-CoV-2 infection in the Researching COVID to Enhance Recovery (RECOVER) database. MISC indicates multisystem inflammatory syndrome in children; PASC, postacute sequelae of SARS-CoV-2. aPositive results include polymerase chain reaction, antigen, and serological tests. bIndicates 24 months to 7 days before the index date. cIndicates 28 to 179 days before the index date.
Figure 2.
Figure 2.. Adjusted Risk Ratios (ARRs) for Gastrointestinal (GI) Tract Outcomes in COVID-19–Positive vs –Negative Patients by Phase
The outcomes are grouped by signs or symptoms, disorders, and composite outcomes. The postacute phase spans 28 to 179 days after cohort entry date, and the chronic phase spans 180 to 729 days after cohort entry date. The false discovery rate (FDR) is controlled by applying the Benjamini-Hochberg procedure. GERD indicates gastroesophageal reflux disease; IBS, irritable bowel syndrome.
Figure 3.
Figure 3.. Subgroup Analysis of Adjusted Risk Ratios (ARR) for Gastrointestinal (GI) Tract Outcomes
COVID-19–positive and –negative patients are compared across the postacute phase (28-179 days after cohort index date) and the chronic phase (180-729 days after cohort index date). Subgroups include age, race and ethnicity, sex, COVID-19 variant period, cardiovascular conditions, diabetes, obesity, severity of COVID-19, and hospitalization status. ICU indicates intensive care unit.
See this image and copyright information in PMC

References

    1. Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023;21(3):133-146. doi:10.1038/s41579-022-00846-2 - DOI - PMC - PubMed
    1. Davis HE, Assaf GS, McCorkell L, et al. . Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine. 2021;38:101019. doi:10.1016/j.eclinm.2021.101019 - DOI - PMC - PubMed
    1. Thaweethai T, Jolley SE, Karlson EW, et al. ; RECOVER Consortium . Development of a definition of postacute sequelae of SARS-CoV-2 infection. JAMA. 2023;329(22):1934-1946. doi:10.1001/jama.2023.8823 - DOI - PMC - PubMed
    1. Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590. doi:10.1038/s41591-022-01689-3 - DOI - PMC - PubMed
    1. Al-Aly Z, Bowe B, Xie Y. Long COVID after breakthrough SARS-CoV-2 infection. Nat Med. 2022;28(7):1461-1467. doi:10.1038/s41591-022-01840-0 - DOI - PMC - PubMed

Publication types