Heartburn, a common sensation of burning in the chest, affects many individuals. The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has impacted global health in numerous ways. While primarily known for respiratory symptoms, a growing body of evidence suggests a potential link between COVID-19 infection and the development or worsening of heartburn. This article explores the observed connection between COVID-19 and heartburn, the biological factors that may contribute to this symptom, and practical strategies for managing heartburn. It also outlines when seeking medical attention for heartburn is advisable.
The Connection Between COVID-19 and Heartburn
Many individuals have reported experiencing heartburn or a worsening of existing heartburn during or after a COVID-19 infection. Studies indicate that gastrointestinal symptoms, including acid reflux, are reported by a notable percentage of COVID-19 patients, with some research showing that up to 29% experienced reflux symptoms six months after recovery. One study found that people who had COVID-19 had a 35% heightened risk of developing acid reflux disease in the year following infection. This connection is an area of ongoing scientific investigation. Although direct causality is still being fully understood, the observed increase in heartburn complaints highlights a potential impact of the virus beyond the respiratory system.
Biological Factors Contributing to Heartburn During or After COVID-19
Several biological mechanisms may explain why individuals experience heartburn during or after a COVID-19 infection. The systemic inflammation triggered by the SARS-CoV-2 virus can affect various organs, including the digestive tract. This widespread inflammation might irritate the esophagus and stomach lining, leading to increased acid sensitivity and heartburn.
The virus itself may also directly impact gastrointestinal cells. SARS-CoV-2 binds to angiotensin-converting enzyme 2 (ACE2) receptors, found not only in the lungs but also abundantly in digestive system cells, including the small intestine and stomach. While healthy esophageal cells generally lack these receptors, cells in individuals with conditions like Barrett’s esophagus, associated with chronic reflux, can develop them, potentially making them vulnerable to direct viral infection and disrupting normal digestive function.
Physiological stress from illness can also significantly influence gut function. Stress can alter gut motility, potentially slowing down the movement of food through the digestive tract and increasing acid production. This heightened stress response can make the esophagus more sensitive to acid, causing or worsening heartburn symptoms.
Medications taken to manage COVID-19 symptoms can inadvertently exacerbate heartburn. For example, non-steroidal anti-inflammatory drugs (NSAIDs), commonly used for fever and pain relief, are known to irritate the stomach lining and can lead to heartburn.
Changes in the gut microbiome, the community of microorganisms residing in the digestive tract, represent another contributing factor. COVID-19 infection can disrupt the delicate balance of beneficial and harmful bacteria in the gut, a condition known as dysbiosis. This imbalance can lead to various gastrointestinal issues, including bloating, acid reflux, and ongoing inflammation.
When to Seek Medical Attention for Heartburn
While occasional heartburn is common, certain symptoms warrant prompt medical evaluation to rule out more serious conditions. If heartburn becomes more severe or frequent, or if it persists despite using over-the-counter medications for more than two weeks, medical advice should be sought.
Other concerning symptoms that necessitate a doctor’s visit include difficulty or pain when swallowing, unexplained weight loss, or the presence of black or bloody stools. Chest pain accompanied by symptoms like pain in the neck, jaw, arms, or shortness of breath, sweating, or an irregular pulse should be immediately evaluated as these could indicate a cardiac issue. If heartburn significantly interferes with daily activities or sleep, or if it is accompanied by chronic hoarseness or a persistent cough, consulting a healthcare professional is important.
Strategies for Managing Heartburn
Managing heartburn often involves a combination of dietary adjustments and lifestyle changes. Avoiding trigger foods is a primary step; common culprits include spicy or fatty foods, caffeine, chocolate, and alcohol. Eating smaller, more frequent meals instead of large ones can also help reduce stomach pressure and acid reflux.
Lifestyle modifications play a significant role in alleviating heartburn. It is advisable to avoid lying down immediately after eating, allowing at least three hours for digestion before bedtime. Elevating the head of the bed by six to nine inches can help prevent stomach acid from flowing back into the esophagus during sleep. Maintaining a healthy weight is beneficial, as excess weight can put pressure on the abdomen, potentially worsening reflux. Quitting smoking is also recommended, as nicotine can weaken the lower esophageal sphincter, the muscle that prevents acid reflux.
Over-the-counter remedies can provide temporary relief. Antacids, such as calcium carbonate, can quickly neutralize stomach acid. H2 blockers, like famotidine, reduce acid production and offer longer-lasting relief, typically working within one to three hours. Proton pump inhibitors (PPIs), such as omeprazole, are designed for frequent heartburn and work by significantly reducing stomach acid, though they may take a few days to reach full effect. For persistent or severe symptoms, or for long-term use of these medications, consulting a doctor is advisable.