Risk of acute gastroenteritis following COVID-19 exposure: a retrospective population-based analysis conducted in England
- 1University of Liverpool
Abstract
BackgroundSevere COVID-19 is associated with immune dysregulation, microbiome disruption, and increased vulnerability to secondary infections. However, the longer-term risk of acute gastroenteritis (AGE) following COVID-19 remains poorly studied. We compared AGE incidence among community-managed and hospitalised COVID-19 patients with test-negative controls and hospitalised sepsis patients.
MethodsWe conducted a retrospective cohort study using electronic healthcare data. Patients with a recorded SARS-CoV-2 PCR test between 01 March 2020 and 01 March 2022 were allocated to test-negative, community COVID-19, or hospitalised COVID-19 cohorts. A hospitalised sepsis cohort was assembled for an age-, sex- and time-matched analysis. AGE incidence rates were calculated for the two years before enrolment and during follow-up. Negative binomial regression and conditional Poisson models estimated incidence rate ratios (IRRs) adjusting for demographic and clinical covariates.
ResultsAmong 788 103 patients, AGE incidence in the pre-pandemic period was higher among individuals later hospitalised with COVID-19 or sepsis compared with community cases. During follow-up, AGE incidence was slightly lower in community COVID-19 cases than test-negative controls (adjusted IRR 0{middle dot}88 [95% CI 0{middle dot}85-0{middle dot}92]), but substantially higher among hospitalised COVID-19 patients (IRR 5{middle dot}80 [95% CI: 5{middle dot}38-6{middle dot}25]). Matched analyses confirmed increased AGE rates compared with community controls (IRR 4{middle dot}63 [95% CI: 4{middle dot}15-5{middle dot}17]) and hospitalised sepsis controls (IRR 1{middle dot}41 [95% CI 1{middle dot}21-1{middle dot}64]).
ConclusionsCOVID-19 hospitalisation is associated with a marked increase in AGE risk after discharge, exceeding that associated with sepsis hospitalisation. By contrast, lower AGE rates in community COVID-19 cases likely reflect baseline differences rather than protective effects of infection. Overall, these findings demonstrate heightened post-discharge vulnerability to gastrointestinal illness after COVID-19 hospitalisation and support the need for improved follow-up and surveillance strategies.
FundingNational Institute for Health Research
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BibTeX
@misc{hawkings2026risk,
title = {{Risk of acute gastroenteritis following COVID-19 exposure: a retrospective population-based analysis conducted in England}},
author = {M. J. Hawkings and D. M. Hughes and A. J. Elliot and I. E. Buchan and D. Hungerford},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.07.26362439},
url = {https://www.medrxiv.org/content/10.64898/2026.09.07.26362439v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Risk of acute gastroenteritis following COVID-19 exposure: a retrospective population-based analysis conducted in England
AU - M. J. Hawkings
AU - D. M. Hughes
AU - A. J. Elliot
AU - I. E. Buchan
AU - D. Hungerford
PY - 2026
DA - 2026/09/07
PB - medRxiv
DO - 10.64898/2026.09.07.26362439
UR - https://www.medrxiv.org/content/10.64898/2026.09.07.26362439v1
AB - BackgroundSevere COVID-19 is associated with immune dysregulation, microbiome disruption, and increased vulnerability to secondary infections. However, the longer-term risk of acute gastroenteritis (AGE) following COVID-19 remains poorly studied. We compared AGE incidence among community-managed and hospitalised COVID-19 patients with test-negative controls and hospitalised sepsis patients. MethodsWe conducted a retrospective cohort study using electronic healthcare data. Patients with a recorded SARS-CoV-2 PCR test between 01 March 2020 and 01 March 2022 were allocated to test-negative, community COVID-19, or hospitalised COVID-19 cohorts. A hospitalised sepsis cohort was assembled for an age-, sex- and time-matched analysis. AGE incidence rates were calculated for the two years before enrolment and during follow-up. Negative binomial regression and conditional Poisson models estimated incidence rate ratios (IRRs) adjusting for demographic and clinical covariates. ResultsAmong 788 103 patients, AGE incidence in the pre-pandemic period was higher among individuals later hospitalised with COVID-19 or sepsis compared with community cases. During follow-up, AGE incidence was slightly lower in community COVID-19 cases than test-negative controls (adjusted IRR 0{middle dot}88 [95% CI 0{middle dot}85-0{middle dot}92]), but substantially higher among hospitalised COVID-19 patients (IRR 5{middle dot}80 [95% CI: 5{middle dot}38-6{middle dot}25]). Matched analyses confirmed increased AGE rates compared with community controls (IRR 4{middle dot}63 [95% CI: 4{middle dot}15-5{middle dot}17]) and hospitalised sepsis controls (IRR 1{middle dot}41 [95% CI 1{middle dot}21-1{middle dot}64]). ConclusionsCOVID-19 hospitalisation is associated with a marked increase in AGE risk after discharge, exceeding that associated with sepsis hospitalisation. By contrast, lower AGE rates in community COVID-19 cases likely reflect baseline differences rather than protective effects of infection. Overall, these findings demonstrate heightened post-discharge vulnerability to gastrointestinal illness after COVID-19 hospitalisation and support the need for improved follow-up and surveillance strategies. FundingNational Institute for Health Research
ER -