Scrub typhus (ST) is reported from almost every Indian state. In our tertiary care teaching hospital at Puducherry, we looked for gastrointestinal (GI) manifestations of ST in children as well as adults and correlated with laboratory findings. We examined 588 serum samples for immunoglobulin M (IgM) antibody against Orientia tsutsugamushi by enzyme-linked immunosorbent assay (ELISA) and observed that 335 (56.97%) of these clinically suspected ST patients were positive, comprising 134 children and 201 adults. Statistically significant (p ≤ 0.05) number of adults had nausea (p = 0.000) and abdominal pain (p = 0.020) than children. Similar trend was observed in adults with reference to increased liver enzymes (aspartate aminotransferase/alanine aminotransferase/alkaline phosphatase; p = 0.000), creatinine (>1.0 mg/dL; p = 0.007), and platelet count (≤1.5 lakhs/mm³; p = 0.026). Rash in children is the only statistically significant manifestation than adults (p = 0.03). More number of children were positive than adults, but without any statistical significance, with reference to other parameters like cough/expectoration (p = 0.735), hepatomegaly (p = 0.730), and eschar (p = 0.721). How to cite this article Anitharaj V, Gunasekaran D, Pradeep J, Stephen S. Gastrointestinal Manifestations of Scrub Typhus in Children and Adults from Puducherry and Neighboring Tamil Nadu State, India. J Gastro Infect 2017;7(1):1-4.