S910 Long COVID Is Associated With an Increased Risk of Developing GERD and Related Complications

Introduction: Long COVID is a chronic condition resulting from SARS-CoV-2 infection. While most associated with respiratory conditions, gastrointestinal symptoms including reflux occur in almost one-third of patients 6 months following COVID-19 infection. Our study aimed to evaluate whether long COVID increases the risk of gastroesophageal reflux disease (GERD) subtypes, including erosive esophagitis (EE) and non-erosive reflux disease (NERD) and complications like esophageal strictures. Methods: This retrospective cohort study utilized the TriNetX U.S. database to assess the risk of developing GERD and its complications among patients diagnosed with long COVID versus matched controls without long COVID. Patients with prior GERD, systemic sclerosis, or prior esophageal/gastric surgery were excluded. Cohorts included patients diagnosed after October 2021 (post-establishment of the long COVID International Classification of Diseases code). Analyses involved 1:1 propensity-score matching, stratified into four age groups: 18-34 years, 35-50 years, 51-69 years, and ≥70 years. Outcomes were assessed using Cox-proportional hazard ratio (HR) analyses, examining the risks of EE, NERD, and esophageal strictures. Results: Long COVID significantly increased risks for GERD subtypes and related complications across all age groups, with the highest risk for EE and esophageal strictures observed in patients aged ≥70 years. Specifically, among the youngest cohort (18-34 years, N = 14,467 each), long COVID patients exhibited a higher risk of EE (HR 1.48; 95% confidence interval [CI] 1.11-1.98). In the 35-50-year group (N = 24,217 each), elevated risks were seen for EE (HR 1.69; 95% CI 1.39-2.06), NERD (HR 1.72; 95% CI 1.62-1.83), and esophageal strictures (HR 1.81; 95% CI 1.21-2.68). For the 51-69-year group (N = 33,233 each), there was a significantly increased risk of NERD (HR 1.65; 95% CI 1.57-1.73). The oldest cohort (≥70 years, N = 19,135 each) showed heightened risks for EE (HR 1.80; 95% CI 1.48-2.18) and esophageal strictures (HR 1.84; 95% CI 1.38-2.45). Conclusion: Long COVID is associated with increased risk of developing GERD (NERD and EE) and esophageal strictures. While potentially attributable to inflammation and dysbiosis, future research is needed to further elucidate the mechanisms of this relationship. Further research should investigate underlying pathophysiological mechanisms and potential long-term consequences such as Barrett’s esophagus and esophageal adenocarcinoma.