From the Guidelines
COVID-19 can cause esophageal dysfunction, particularly achalasia, through mechanisms involving direct viral invasion, inflammation, and nervous system effects, as supported by recent studies 1. The relationship between COVID-19 and esophageal dysfunction is complex and multifaceted. Patients with COVID-19 may experience symptoms like difficulty swallowing, heartburn, regurgitation, and chest pain due to various mechanisms.
- Direct viral invasion of esophageal tissue
- Inflammation
- Nervous system effects Treatment typically includes proton pump inhibitors (PPIs) like omeprazole 20-40mg daily or pantoprazole 40mg daily for 4-8 weeks to reduce acid production.
- H2 blockers such as famotidine 20mg twice daily can be used as alternatives
- For motility issues, prokinetics like metoclopramide 10mg before meals may help Lifestyle modifications are also important:
- Elevate the head of the bed 6-8 inches
- Avoid eating 2-3 hours before bedtime
- Eliminate trigger foods (spicy, fatty, acidic)
- Maintain a healthy weight Most COVID-related esophageal symptoms improve within weeks to months as the infection resolves, but some patients may experience persistent symptoms requiring longer treatment. The mechanism involves both direct viral damage to esophageal tissue through ACE2 receptors and systemic inflammation affecting esophageal function. Neurological effects of COVID-19 can also disrupt the complex neural control of swallowing and esophageal motility, as seen in cases of post-COVID-19 achalasia 1. In suspected cases, diagnostic tests such as upper endoscopy, high-resolution esophageal manometry, and timed barium esophagram with pill can help rule out other diagnoses and confirm the presence of esophageal dysfunction 1.
From the Research
Relationship between COVID-19 and Esophageal Dysfunction
The relationship between COVID-19 and esophageal dysfunction is complex and multifaceted. Key aspects of this relationship include:
- Dysphagia, or difficulty swallowing, is a common symptom in COVID-19 patients, particularly those who are critically ill 2, 3.
- Esophageal dysfunction in COVID-19 patients can be caused by a variety of factors, including respiratory distress, deconditioning, and neurological complications 2.
- Mechanical ventilation, delirium, sedation, and weakness can exacerbate esophageal dysfunction in COVID-19 patients 2.
- Tracheostomy may be necessary in some cases to reduce laryngopharyngeal trauma, sedation, and delirium, and to improve swallowing rehabilitation 2.
Prevalence and Management of Dysphagia in COVID-19 Patients
- Dysphagia is highly prevalent in severe COVID-19 patients, with one study finding that 86.6% of patients experienced dysphagia 3.
- A structured swallowing-exercise training intervention based on inspiratory/expiratory muscle strength training (IEMT) and neuromuscular stimulation (NMES) has been shown to be feasible and safe in COVID-19 patients with prolonged hospitalization 3.
- The Latin American Dysphagia Society has developed a position statement providing guidance for the management of oropharyngeal and esophageal dysphagia during the COVID-19 pandemic, including evaluation and treatment guidelines for different contexts 4.
Esophageal Motility Disorders and COVID-19
- Esophageal hypomotility, including ineffective esophageal motility, is a common motility disorder that can result in symptoms such as dysphagia and gastroesophageal reflux 5.
- The correlation between esophageal hypomotility and esophageal symptoms is complex and not well established, and the beneficial effects of prokinetic agents are limited 5.
- There is no direct evidence linking COVID-19 to esophageal motility disorders, but the pandemic has highlighted the need for adapted management strategies for patients with dysphagia and other esophageal symptoms 2, 3, 4, 6.