Long COVID-19 and achalasia: a possible relationship?
Keywords:Esophageal achalasia, COVID-19, SARS-CoV-2 infection
Achalasia is a rare esophageal motor disorder with a worldwide prevalence of around 10 cases per 100 000 inhabitants, and an incidence of one new case per 100 000 inhabitants per year. It is characterized by loss or decrease of myenteric plexus neurons in the distal esophagus and lower esophageal sphincter, presenting dysphagia and regurgitation. The objective of this work was to show that the presence of type II achalasia could be a sequela of the COVID-19 infection. Patient histories were reviewed during the 2015-2021 period, the frequencies of achalasia with and without COVID-19 were calculated. Patient profiles were constructed by using cluster analysis based on clinical variables. It was found that frequency of patients with achalasia during the years 2020 and 2021 was higher than that observed in previous years, and by the year 2021, 2/3 of the patients with achalasia had presented COVID-19 infection, in addition, the patients with type I achalasia presented different profiles than patients with type II achalasia according to the cluster analysis, and the frequency of COVID-19 was much lower in patients with type I achalasia. These results seem to indicate type II achalasia could be a sequela of COVID-19 infection. The possible etiopathogenic implications of these results are discussed, as well as their clinical relevance.
Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108(8):1238-49.
Mascolo A, Scavone C, Rafaniello C, Ferrajolo C, Racagni G, Berrino L, et al. Renin-Angiotensin system and coronavirus disease 2019: a narrative review. Front Cardiovasc Med. 2020;7:143.
Cheung KS, Hung IFN, Chan PPY, Lung KC, Tso E, Liu R, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: systematic review and meta-analysis. Gastroenterology. 2020;159(1):81-95.
Casselbrant A, Edebo A, Hallersund P, Spak E, Helander HF, Jönson C, et al. Angiotensin II receptors are expressed and functional in human esophageal mucosa. Am J Physiol Gastrointest Liver Physiol. 2009;297(5):G1019-27.
Pandolfino JE, Gawron AJ. Achalasia: a systematic review. JAMA. 2015;313(18):1841-52.
Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160-74.
Gaber CE, Cotton CC, Eluri S, Lund JL, Farrel TM, Dellon ES. Autoimmune and viral risk factors are associated with achalasia: a case – control study. Neurogastroenterolol Motil. 2021;e14312.
Sodikoff JB, Lo AA, Shetuni BB, Kahrilas PJ, Yang, GY, Pandolfino JE. Histopathologic patterns among achalasia subtypes. Neurogastroenterol Motil. 2016;28(1):139-45.
Casselbrant A, Kostic S, Lönroth H. The muscular expression of RAS in patients with achalasia. J Renin Angiotensin Aldosterone Syst. 2015;16(3):578-86.
Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation. J Med Virol. 2021;93(2):1013-22.
Crook H, Raza S, Nowell J, Young M, Edison P. Long covid-mechanisms, risk factors, and management. BMJ. 2021;374:n1648.