A subset of children who have had COVID-19 and/or multisystem inflammatory syndrome in children (MIS-C) develop functional gastrointestinal disorders (FGID)

Background: Gastrointestinal symptoms are increasingly recognized as prominent features of pediatric Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, particularly in patients with MIS-C. Prior studies report post-infectious FGIDs in children, but the relationship between SARS-CoV-2 infection +/- MIS-C with subsequent FGIDs has yet to be characterized. Here we report the prevalence of FGIDs, changes in Irritable Bowel Syndrome-Symptom Severity Score (IBS-SSS), and risk factors in a cohort of pediatric patients following two manifestations of SARS-CoV-2 infection, coronavirus disease 2019 (COVID-19) and MIS-C. Methods: A retrospective study of patients between the ages of 4-18 years with COVID-19 or MIS-C who were seen at New York Presbyterian Morgan Stanley Children's Hospital from April 2020 to February 2021. Identified, consented patients were contacted via email and/or phone and asked to complete online surveys consisting of the ROME IV diagnostic questionnaire for FGIDs and the IBS-SSS, based on their symptoms prior to and >3months following infection. The questionnaire relied on parent report for children >4 years of age and child self-report >10 years of age. T-tests and chi-square tests were used to analyze continuous and categorical demographic variables, respectively, between the two groups. Changes in IBS-SSS and FGID prevalence were analyzed with the Wilcoxon Signed-Rank test and chi-square test, respectively. A p-value <0.05 was considered statistically significant. Results: 103 COVID-19 and 35 MIS-C patients were identified. Patients were contacted with a priority towards age- and sex-matching between groups. Twenty three (12 COVID-19 and 11 MIS-C) verbal patients completed the surveys. The cohorts were statistically similar in average age (10.6 vs 12.0 years;p = 0.403), proportion of males (58.3% vs 54.5%;p = 0.855) and race and Hispanic ethnicity (58.3% vs 54.5%;p = 0.855) (Table 1). Among COVID-19 patients, the average change in IBSS-SSS was +75 (range: -120 to +500) with 6/12 patients reporting worsening abdominal pain. Within the MIS-C cohort, 5/11 patients reported worsening pain and the average change in IBS-SSS was +33 (range: -320 to + 300). Changes in IBS-SSS were not statistically different between the two groups (p = 0.780). Collectively, COVID-19 and MIS-C patients experienced an average increase of 55.2 points in IBS-SSS following SARS-CoV-2 infection that was not statistically significant (p = 0.061). 21.7% of patients (3 COVID-19;2 MIS-C) developed a new FGID (functional abdominal pain (FAP) and functional dyspepsia-post prandial distress syndrome (FD-PDS)) following infection (Table 2). Though this joint change was not statistically significant (p = 0.084) nor were the differences in total new FGIDs between the COVID-19 and MISC groups (p = 0.611), this number is statistically higher than the reported prevalence of these conditions nationally. No significant differences were present in sex, ethnicity, body mass index or peak C- Reactive Protein levels with changes in IBS-SSS and development of FGIDs. Conclusions: Our study is one of the first retrospective surveys to compare the impact of SARS-CoV-2 infection on FGIDs in COVID-19 +/- MIS-C pediatric patients. While no significant differences were found between cohorts, potentially in part due to the small sample size, a large percentage of the individuals screened developed worsening IBS-SSS and/or onset of FGIDs post-infection. These findings suggest that more research, with larger cohorts, is necessary to understand the long-term impact of COVID-19 infection on development of FGID.