GERD is a chronic digestive condition where stomach acid frequently flows back into the tube connecting your mouth and stomach, called the esophagus. This backwash, known as acid reflux, can irritate the esophageal lining, leading to symptoms like heartburn and regurgitation. Since the beginning of the pandemic, many individuals have reported an unexpected worsening of their existing GERD symptoms or the new onset of reflux issues following a COVID-19 infection. This connection suggests that the virus can directly impact the mechanisms that normally prevent stomach acid from escaping the stomach. Understanding this relationship is important for managing digestive health during and after an illness caused by the SARS-CoV-2 virus.
Acute COVID-19 and GERD Symptom Exacerbation
The acute phase of a COVID-19 infection frequently coincides with a noticeable increase in the severity and frequency of typical GERD symptoms. Patients already diagnosed with GERD often experience a flare-up of heartburn, regurgitation, and non-cardiac chest pain while they are actively ill.
Beyond the worsening of pre-existing conditions, the acute infection has also been linked to the development of new GERD symptoms in individuals who previously had no history of reflux. A significant number of patients report lingering gastrointestinal issues, including heartburn, as part of the post-COVID condition, sometimes referred to as long COVID. Some studies examining individuals with long COVID have found that nearly half of the participants report gastroesophageal acid reflux.
Physiological Reasons COVID-19 Worsens Reflux
The SARS-CoV-2 virus and the resulting illness can worsen reflux through multiple physiological pathways.
Systemic Inflammation
One primary mechanism involves the intense systemic inflammation triggered by the infection, often called a cytokine storm. This widespread inflammatory response can irritate the lining of the esophagus and potentially interfere with the proper functioning of the lower esophageal sphincter (LES). The LES is the ring of muscle that acts as a barrier to keep stomach contents in the stomach. When the LES relaxes inappropriately, stomach acid is allowed to reflux more easily.
Increased Intra-Abdominal Pressure
A second, mechanical factor is the persistent and forceful coughing that is a hallmark symptom of COVID-19 in many patients. Each cough creates a sudden and dramatic increase in intra-abdominal pressure, essentially squeezing the stomach. This repeated pressure surge can physically push stomach acid upward past a normally functioning LES. The consistent mechanical strain can also contribute to weakening the LES over time.
Vagus Nerve Dysfunction
Emerging research suggests that the virus may directly or indirectly affect the nervous system, specifically the vagus nerve. The vagus nerve is a major component of the autonomic nervous system and plays a vital role in regulating gut motility, stomach emptying, and the function of the LES. Viral injury or inflammation affecting this nerve may lead to reduced esophageal-gastric-intestinal movement and impaired LES control, both of which contribute to reflux. Studies show that patients with long COVID who report vagus nerve dysfunction symptoms are more likely to also report gastroesophageal reflux.
Managing GERD Symptoms During and After Infection
Managing GERD symptoms during and after a COVID-19 infection involves medication review and specific lifestyle adjustments. For individuals taking acid-reducing medications (such as PPIs or H2 blockers), a physician may need to adjust the dosage or switch the type of medication. Discuss all medications with a healthcare provider, especially since some COVID-19 treatments, like corticosteroids, can relax the LES and potentially worsen reflux.
Patients should exercise caution when using over-the-counter pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can irritate the stomach lining and exacerbate acid reflux. Acetaminophen is considered a safer alternative for pain and fever control. Simple lifestyle modifications can offer significant relief:
- Eating smaller, more frequent meals and avoiding lying down for at least two or three hours after eating.
- Elevating the head of the bed by six to nine inches using blocks or a wedge under the mattress to prevent nighttime reflux.
- Practicing stress management techniques, as psychological stress is known to increase GERD symptoms.
- Maintaining adequate hydration, as drinking water can help soothe the throat and clear any acid that has refluxed into the esophagus.