Can current chronic reflux gastritis regurgitation with globus sensation be a sequela of COVID-19 (Coronavirus Disease 2019)?

Chronic Reflux Gastritis and Globus Sensation as Potential Sequelae of COVID-19

COVID-19 infection can cause gastrointestinal manifestations including reflux gastritis and globus sensation, though these are not among the most common GI sequelae reported in the literature. Based on current evidence, while COVID-19 primarily affects the respiratory system, it can also impact the gastrointestinal tract through various mechanisms.

Gastrointestinal Manifestations of COVID-19

• Gastrointestinal symptoms occur in less than 10% of COVID-19 patients overall, with higher rates (up to 20%) reported in studies outside of China 1
• The most common GI symptoms associated with COVID-19 include:
  • Diarrhea (7.7% prevalence, 95% CI: 7.2%-8.2%) 1
  • Nausea/vomiting (7.8% prevalence, 95% CI: 7.1%-8.5%) 1
  • Abdominal pain (2.7% prevalence, 95% CI: 2.0%-3.4%) 1
• Reflux symptoms and globus sensation are not specifically highlighted among the most common GI manifestations in major COVID-19 studies 1

Potential Mechanisms for COVID-19-Related Reflux and Globus Sensation

• SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) as its entry receptor, which is abundantly expressed in gastric, duodenal, and rectal epithelia 1
• This receptor distribution may explain direct viral effects on the GI tract, potentially leading to inflammation that could manifest as reflux symptoms 1, 2
• Recent research suggests genetic correlations between COVID-19 infection and GERD susceptibility, indicating a possible shared genetic basis 2
• Post-COVID sequelae affecting the GI tract have been documented, though specific studies on reflux and globus sensation are limited 3

Evidence for COVID-19 as a Cause of Chronic Reflux and Globus Sensation

• A 2024 case report described a patient with symptoms suggestive of refractory GERD for 18 months following COVID-19 infection, though these symptoms were ultimately attributed to chronic pulmonary embolism rather than primary GERD 3
• A 2024 review article specifically examining the relationship between COVID-19 and gastroesophageal reflux noted that both conditions share risk factors and can present with similar symptoms 2
• The AGA Institute's rapid review of GI manifestations in COVID-19 did not specifically identify reflux or globus sensation as common manifestations 1

Diagnostic Considerations

• For patients with new-onset GI symptoms (including reflux and globus sensation) following COVID-19:
  • Obtain a thorough history of symptom onset, characteristics, duration, and severity 1
  • Consider whether symptoms began during acute COVID-19 infection or developed as post-COVID sequelae 1, 3
  • Rule out other potential causes of symptoms, as COVID-19 sequelae can masquerade as primary GI conditions 3
• Monitor for other COVID-19-associated symptoms that may suggest ongoing systemic effects 1

Clinical Implications and Management

• In patients with suspected post-COVID reflux symptoms:
  • Standard GERD evaluation and management approaches should be employed initially 2
  • Consider the possibility of COVID-19-related inflammation or other systemic effects if symptoms are refractory to standard treatments 3, 2
  • Be aware that some apparent reflux symptoms following COVID-19 may be due to other post-COVID complications (such as pulmonary issues) rather than primary GERD 3

Limitations of Current Evidence

• Most studies on COVID-19 GI manifestations have focused on hospitalized patients, potentially underestimating prevalence in those with milder disease 1
• Long-term follow-up studies specifically examining chronic reflux and globus sensation after COVID-19 are limited 2
• The relationship between COVID-19 and GERD/reflux symptoms has not been extensively studied 2

While the evidence specifically linking COVID-19 to chronic reflux gastritis and globus sensation is limited, emerging research suggests that COVID-19 can affect the GI tract in various ways, potentially leading to these symptoms in some patients. Further research is needed to better understand the long-term GI sequelae of COVID-19 infection.