medwireNews: Children with COVID-19 have a heightened risk for gastrointestinal (GI) symptoms and disorders for up 2 years after the viral infection, a US study has found.
"[F]rom a clinical perspective, our findings emphasize the importance of considering the documented SARS-CoV-2 infection history when evaluating persistent GI tract symptoms in pediatric patients,” write Yong Chen (University of Pennsylvania, Philadelphia, USA) and colleagues in JAMA Network Open.
They add that “[r]ecognizing this association could reduce unnecessary testing or referrals, enabling clinicians to focus on timely and effective symptom management.”
The researchers collected data from 1,576,933 children with (n=413,455) and without (n=1,163,478) a documented SARS-CoV-2 infection over a period spanning from March 2020 to March 2023. They set an index date for each patient as the first date of documented SARS-CoV-2 infection for the COVID-19-positive cohort or a randomly selected negative test result for the COVID-19-negative cohort.
The participants were aged 18 years and younger and had at least one medical visit within 24 months to 7 days of the index date and subsequently had another encounter 28 to 729 days later.
The participants were a mean of 7.3 years old, 52.0% were boys, and 42.6% were non-Hispanic White. A total of 13.5% had a complex chronic condition as per the Pediatric Medical Complexity Algorithm (PMCA), which categorizes medical conditions into no chronic condition, noncomplex chronic condition, and complex chronic condition.
The medical records were assessed for signs and symptoms of abdominal pain, bloating, constipation, diarrhea, nausea, and vomiting, as well as gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and functional dyspepsia.
In the postacute phase (28 to 179 days after cohort entry date), children who tested positive for COVID-19 were significantly more likely than the COVID-19-negative children to have any GI tract signs or symptoms (8.24 vs 6.45%), with an adjusted risk ratio (ARR) of 1.26 after considering confounding factors such as age, obesity, PMCA, prior healthcare utilization, and history of chronic illness.
The trend persisted into the chronic phase (180 to 729 days after cohort entry date), with respective rates of 12.19% versus 9.13% and a significant ARR of 1.28.
Chen et al found that children with COVID-19 were significantly more likely than those without to have GERD, IBS, or dyspepsia in both the postacute (1.27 vs 1.12%; ARR=1.19) and chronic (1.82 vs 1.40%; ARR=1.28) phases. They also had significantly more visits to a healthcare provider that were related to the GI tract in the postacute (8.64 vs 6.85%; ARR=1.25) and chronic phases (12.60 vs 9.47%; ARR=1.28).
When the investigators analyzed specific GI conditions in the postacute phase, the COVID-19-positive group had a significantly higher rate of abdominal pain (2.54 vs 2.06%; ARR=1.14), bloating (0.28 vs 0.23%; ARR=1.27), constipation (2.94 vs 2.42%; ARR=1.20), diarrhea (2.30 vs 1.57%; ARR=1.40), nausea (0.81 vs 0.56%; ARR=1.27), and vomiting (2.98 vs 2.29%; ARR=1.33) than the COVID-19-negative children. There was also a significantly increased risk for GERD with a history of COVID-19 infection (1.15 vs 1.00%; ARR=1.19) but, by contrast, there was no increased risk for IBS in the COVID-19-positive group.
There was a similar increase in specific signs and symptoms in the chronic phase among children with a history of COVID-19 infection compared with negative controls, with significant ARRs for abdominal pain, bloating, constipation, diarrhea, nausea, and vomiting, as well as for GERD (ARR=1.24, 1.30, 1.23, 1.48, 1.38, 1.40, and 1.28, respectively).
Chen and colleagues say that these findings “highlighted the persistent higher health risks among individuals with documented COVID-19 across a range of GI tract outcomes for the chronic phase,” adding that larger ARRs in the chronic phase than in the postacute phase signal “a prolonged increased risk of the documented infection on GI tract health.”
When analyzing subgroups by age, the investigators found that children younger than 5 years old were at the highest risk for GI disorders or symptoms after COVID-19 infection, with ARRs of 1.31 and 1.36 during the postacute and chronic phases, respectively. By contrast, children aged 5–12 years and over 12 years had ARRs no higher than 1.23 in either phase.
The risk for GI disorders or symptoms with versus without COVID-19 infection was significantly higher in boys than girls during the postacute phase, while patients without obesity had a significantly higher risk than those with during both phases.
There was also a significantly greater risk for postacute and chronic GI outcomes with greater COVID-19 severity of symptoms, including a progressive increase noted for children who had required hospitalization or an intensive care unit stay.
The authors say that their findings “highlight the importance of ongoing monitoring for [the postacute sequelae of SARS-CoV-2] outcomes in children and calls for further research to understand underlying mechanisms and improve targeted care.”
They continue: “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.”
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