Prevalence of Gastrointestinal Symptoms in Children with COVID-19 Hospitalized at Shahid Sadoughi Hospital in Yazd

Abstract

Background: COVID-19 affects the respiratory system, but GI manifestations are recognized in children. These symptoms may precede or accompany respiratory manifestations, making their recognition important for diagnosis. This study aimed to investigate the frequency of GI manifestations and their association with characteristics and disease severity among hospitalized children with COVID-19.

Methods: This retrospective cross-sectional study included 191 children <18 years with COVID-19 hospitalized at a referral hospital in Yazd, between 2020 and 2021. Demographic, laboratory, radiological, and GI data were extracted from the COVID-19 registry and medical records. Disease severity was classified per WHO criteria. Statistical analysis was performed using the Chi-square test.

Results: Among 191 children, 78 (40.8%) had ≥1 GI manifestation. Common symptoms were diarrhea (26.5%), vomiting (25.4%), and abdominal pain (13.6%). No significant associations were found between GI manifestations and sex, underlying conditions, ALT levels, prognosis, ICU admission, or hospitalization length (p > 0.05). Nausea showed a significant association with age (p = 0.01), being prevalent among adolescents aged 13– 16 years (16.7%), while weight loss was associated with elevated AST (p = 0.04). Diarrhea was the only GI symptom associated with severity, occurring more frequently in non-severe vs. severe disease (34.4% vs. 18.7%, p = 0.01).

Conclusion: GI manifestations are common in hospitalized children with COVID-19 and may facilitate early recognition. Although diarrhea was associated with severity, it was more frequent in non-severe cases and should not be considered an independent marker of severe illness. Severity assessment should be based on clinical presentation rather than GI manifestations alone.