Esophageal achalasia, an unexpected complication of COVID-19 post palatoplasty: a case report and literature review


  • Azuka R. Njokanma Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria; Department of Oral and Maxillofacial Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
  • Adetayo Aborisade Department of Oral Diagnostic Sciences, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
  • Olugbenga O. Ojo Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
  • Adewale C. Adeyemi Department of Oral and Maxillofacial Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
  • Ada H. Njokanma Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
  • Collins C. Adumah Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria



Esophageal achalasia, COVID-19, SARS-Cov-2, Cleft palate


The COVID-19 pandemic, caused by SARS-COV-2, has led to significant mortality worldwide. Despite the declaration in May, 2023 by the World Health Organization (WHO), that the COVID-19 pandemic in no longer a public health emergency of international concern, some survivors are experiencing post-infection complications, including esophageal achalasia. Esophageal achalasia is a rare neurodegenerative disorder characterized by impaired esophageal motility and lower esophageal sphincter dysfunction. This study reviews the literature to explore the association between COVID-19 and achalasia and also presents a case of a 9-month-old child diagnosed with achalasia following COVID-19 infection; a unique occurrence in a young child. This study comprises a case report and a literature review. Clinical data for the case report was collected from medical records, while the literature review included a search of electronic databases from January 2020 to October 2023. Keywords related to COVID-19 and esophageal achalasia were utilized to conduct a search in electronic databases resulting in 9 selected articles. This study underscores the emerging concern of esophageal achalasia as a post-infection complication of COVID-19. It provides a unique case of a young child developing achalasia after COVID-19 infection and reviews the limited literature on this association. Further research is needed to understand the underlying mechanisms and potential preventative measures for this rare complication in COVID-19 survivors.


Hillis SD, Unwin HJT, Chen Y, Cluver L, Sherr L, Goldman P, et al. Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study. Lancet. 2021;398(10298):391-402.

Zeidan E, Desilets E, Bouin M, Maniere T. A132 ACHALASIA FOLLOWING A SARS-COV-2 INFECTION: A CASE REPORT. J Can Assoc Gastroenterol. 2022;5(1):3-4.

Mari A, Abu Baker F, Pellicano R, Khoury T. Diagnosis and management of achalasia: updates of the last two years. J Clin Med. 2021;10(16):3607.

Mayberry JF. Epidemiology and demographics of achalasia. Gastrointest Endosc Clin N Am. 2001;11(2):235-47.

Peter SDS, Swain JM. Achalasia: a comprehensive review. Surg Laparosc Endosc Percutan Tech. 2003;13(4):227-40.

Anyanwu C. Achalasia of the oesophagus in Nigeria. J R Coll Surg Edinb. 1982;27(3):146-9.

Ezemba N, Ekwunife C, Eze J. Achalasia in Nigeria. Current status. Chirurgia-Torino. 2007;20(3):14-27.

Howard P, Maher L, Pryde A, Cameron E, Heading R. Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. Gut. 1992;33(8):1011-5.

O'Neill OM, Johnston BT, Coleman HG. Achalasia: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol. 2013;19(35):5806-12.

Aponte R, Daulabani N, Parra R, Pérez-Ybarra L. Long COVID-19 and achalasia: a possible relationship? Int J Community Med Public Health. 2022;9(6):2696-700.

Calì A, La Fortezza RF, Fusaroli P. An Unexpected Thoracic Finding in a Patient With COVID-19. Gastroenterology. 2021;161(4):1111-2.

Furuzawa‐Carballeda J, Icaza‐Chávez ME, Aguilar‐León D, Uribe‐Uribe N, Nuñez‐Pompa MC, Trigos‐Díaz A, et al. Is the Sars‐CoV‐2 virus a possible trigger agent for the development of achalasia? Neurogastroenterol Motil. 2022;e14502.

Gupta R, Mishra G, Dhande R. An Interesting Case of Achalasia Cardia with Co-Existing Coronavirus 19 Infection. J Pharm Res Int. 2021;194-8.

Mohammed FS, Krogel N. Post-COVID-19 Achalasia? Dig Dis Sci. 2023;68(1):333-4.

Ruz Zafra P, García Sánchez CJ, Pérez Ramírez A, Guil Soto A, Leo Carnerero E. Infection with SARS-CoV-2 as a potential achalasia trigger. Rev Esp Enferm Dig. 2023;115(4):203-4.

Ghoshal UC, Daschakraborty SB, Singh R. Pathogenesis of achalasia cardia. World J Gastroenterol. 2012;18(24):3050-7.

Achkar E. Achalasia. The Gastroenterologist. 1995;3(4):273-88.

Patel DA, Lappas BM, Vaezi MF. An Overview of Achalasia and Its Subtypes. Gastroenterol Hepatol. 2017;13(7):411-21.

Park W, Vaezi MF. Etiology and pathogenesis of achalasia: the current understanding. Am J Gastroenterol. 2005;100(6):1404-14.

Eckardt AJ, Eckardt VF. Current clinical approach to achalasia. World J Gastroenterol. 2009;15(32):3969.

Marini T, Desai A, Kaproth-Joslin K, Wandtke J, Hobbs SK. Imaging of the oesophagus: beyond cancer. Insights Imaging. 2017;8(3):365-76.

Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020;115(9):1393-411.

Pasricha PJ, Ravich WJ, Hendrix TR, Sostre S, Jones B, Kalloo AN. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med. 1995;332(12):774-8.

de Moura ETH, Jukemura J, Ribeiro IB, Farias GFA, de Almeida Delgado AA, Coutinho LMA, et al. Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial. World J Gastroenterol. 2022;28(33):4875-89.

Stavropoulos SN, Friedel D, Modayil R, Iqbal S, Grendell JH. Endoscopic approaches to treatment of achalasia. Therap Adv Gastroenterol. 2013;6(2):115-35.

Ates F, Vaezi MF. The Pathogenesis and Management of Achalasia: Current Status and Future Directions. Gut Liver. 2015;9(4):449-63.

Furuzawa-Carballeda J, Torres-Landa S, Valdovinos M, Coss-Adame E, Martín Del Campo LA, Torres-Villalobos G. New insights into the pathophysiology of achalasia and implications for future treatment. World J Gastroenterol. 2016;22(35):7892-907.

Castagliuolo I, Brun P, Costantini M. Esophageal achalasia: is the herpes simplex virus really innocent? J Gastrointest Surg. 2004;8(1):24-30.

Boeckxstaens GE. Achalasia: virus-induced euthanasia of neurons? Am J Gastroenterol. 2008;103:1610-2.

Mousavizadeh L, Ghasemi S. Genotype and phenotype of COVID-19: Their roles in pathogenesis. J Microbiol Immunol Infect. 2021;54(2):159-63.

Schoeman D, Fielding BC. Coronavirus envelope protein: current knowledge. Virol J. 2019;16(1):1-22.

Jackson CB, Farzan M, Chen B, Choe H. Mechanisms of SARS-CoV-2 entry into cells. Nat Rev Mol Cell Biol. 2022;23(1):3-20.

V’kovski P, Kratzel A, Steiner S, Stalder H, Thiel V. Coronavirus biology and replication: implications for SARS-CoV-2. Nat Rev Microbiol. 2021;19(3):155-70.

Ni W, Yang X, Yang D, Bao J, Li R, Xiao Y, et al. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care. 2020;24(1):1-10.

Scialo F, Daniele A, Amato F, Pastore L, Matera MG, Cazzola M, et al. ACE2: The Major Cell Entry Receptor for SARS-CoV-2. Lung. 2020;198(6):867-77.

Goyal RK, Chaudhury A. Physiology of normal esophageal motility. J Clin Gastroenterol. 2008;42(5):610-9.

Casselbrant A, Edebo A, Wennerblom J, Lönroth H, Helander HF, Vieth M, et al. Actions by angiotensin II on esophageal contractility in humans. Gastroenterology. 2007;132(1):249-60.

Lever AF. Angiotensin II, angiotensin-converting enzyme inhibitors, and blood vessel structure. Am J Med. 1992;92(4b):35-8.

Wasim AU, Khan MW, Khan OA, Almatraf KS. Acute-Onset Achalasia Following a Recent COVID-19 Infection: A Case Report. Cureus. 2023;15(5):e38803.

Castillo, RAJ, Llantada-López AR, Benavides-Salgado DE, Alberto J, González G, Alberto JCR, et al. Acute respiratory failure secondary to megaesophagus: think beyond COVID-19. Rev Esp Enferm Dig. 2023;115(4):192-3.

Morin L, Savale L, Pham T, Colle R, Figueiredo S, Harrois A, et al. Four-month clinical status of a cohort of patients after hospitalization for COVID-19. JAMA. 2021;325(15):1525-34.




How to Cite

Njokanma, A. R., Aborisade, A., Ojo, O. O., Adeyemi, A. C., Njokanma, A. H., & Adumah, C. C. (2024). Esophageal achalasia, an unexpected complication of COVID-19 post palatoplasty: a case report and literature review. International Journal Of Community Medicine And Public Health, 11(2), 982–988.



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