Objectives The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut–brain interaction after hospitalisation for SARSCoV-2 infection. Design GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires. Results The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p<0.001). At the 12-month followup, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls. WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. ⇒ Similarly, if SARS-CoV-2 may be a risk factor for disorders of gut–brain interaction is unknown. WHAT THIS STUDY ADDS ⇒ At the 12-month follow-up, compared with controls, patients with COVID-19 reported higher rates of postinfection irritable bowel syndrome (IBS) according to Rome IV criteria. ⇒ Factors significantly associated with new IBS diagnosis included dyspnoea during the acute phase, history of allergies and chronic intake of proton pump inhibitors. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ COVID-19 is associated with an increased risk of long-term gastrointestinal symptoms, including postinfection IBS. ⇒ Given the high prevalence of COVID-19 at the global level, an increase in new-onset disorders of gut–brain interaction should be expected due to COVID-19. on March 26, 2024 by guest. Protected by copyright. http://gut.bmj.com/ Gut: first published as 10.1136/gutjnl-2022-328483 on 9 December 2022. Downloaded from Marasco G, et al. Gut 2023;72:484–492. doi:10.1136/gutjnl-2022-328483 485 COVID-19 Conclusion Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls. Trial registration number NCT04691895. INTRODUCTION The COVID-19 pandemic, caused by SARS-CoV-2, has spread