COVID-19 may leave lingering GI issues in children

In children and adolescents who have contracted COVID-19, gastrointestinal (GI) tract symptoms may remain for up to 2 years, as reported in a large retrospective study.

Analysis of data from more than 1.5 million youths in the US showed that compared with those who did not have a documented SARS-CoV-2 infection, those who did were more likely to experience at least one GI tract symptom or disorder in the postacute phase (28–179 days after documented infection) (8.64 percent vs 6.85 percent; adjusted risk ratio [ARR], 1.25, 95 percent confidence interval [CI], 1.24–1.27) and the chronic phase (180–729 days after documented infection) (12.60 percent vs 9.47 percent; ARR, 1.28, 95 percent CI, 1.26–1.30). [JAMA Netw Open 2025;8:e2458366]

When GI symptoms and disorders in the postacute phase were assessed individually, more children in the COVID-19–positive group than in the COVID-19–negative group had abdominal pain (ARR, 1.14, 95 percent CI, 1.11–1.17), bloating (ARR, 1.27, 95 percent CI, 1.18–1.37), constipation (ARR, 1.20, 95 percent CI, 1.17–1.23), diarrhoea (ARR, 1.40, 95 percent CI, 1.36–1.43), nausea (ARR, 1.27, 95 percent CI, 1.21–1.33), vomiting (ARR, 1.33, 95 percent CI, 1.30–1.36), and GERD (ARR, 1.19, 95 percent CI, 1.15–1.24).

Results in the chronic phase were consistent with those in the postacute phase. Various GI tract symptoms and disorders were more common in the COVID-19–positive group than in the COVID-19–negative group. The investigators noted that the point estimates for each GI tract outcome were higher in the chronic vs postacute phase, indicating a sustained negative impact of the infection on gastrointestinal health.

“Chronic GI tract symptoms following infections [other than SARS-CoV-2] are well-documented in paediatric populations, often without a serious underlying cause,” they said. [Glob Pediatr Health 2015;2:X14568452; J Pediatr 2008;152:812-816]

The high expression of angiotensin-converting enzyme 2 in the inner lining of the small intestine, SARS-CoV-2’s impact on the gut microbiome, prolonged viral faecal shedding, and the virus’ persistence in the GI tract offer potential biological bases for the observed association, according to the investigators. [Nat Immunol 2022;23:194-202; Front Cell Infect Microbiol 2020;10:576551; Gut 2022;71:544-552; Lancet Gastroenterol Hepatol 2020;5:434-435]

“A more profound understanding of the biological mechanisms will contribute to the development of targeted and effective interventions, ultimately improving outcomes for those affected by long-term GI tract disorders,” they added.

Overall, the findings underscore the importance of considering the history of SARS-CoV-2 infection when examining persistent GI symptoms in children. “Recognizing this association could reduce unnecessary testing or referrals, enabling clinicians to focus on timely and effective symptom management,” the investigators said.

For the study, population-based databases within the RECOVER Initiative were used. A total of 1,576,933 paediatric patients (mean age 7.3 years, 52.0 percent male) were included in the analyses, with 413,455 having documented SARS-CoV-2 infection. Of the 1,163,478 patients who did not have a history of COVID-19, 157,800 (13.6 percent) had a complex chronic condition per the Pediatric Medical Complexity Algorithm.

Subgroup analyses indicated that children younger than 5 years were at the highest risk of GI tract disorders or symptoms compared with those in other age groups. Boys were at increased risk of GI tract disorders or symptoms during the postacute phase compared with girls. Interestingly, children with vs without obesity had a reduced risk.

In addition, the number of children with GI-related visits rose with the severity of the acute phase of COVID-19, escalating from the mild to the moderate and severe groups. Finally, the risk of GI tract symptoms during the pre-Delta period was greater than that during the Omicron or Delta period.