International Journal of Community Medicine and Public Health | June 2022 | Vol 9 | Issue 6 Page 2696 International Journal of Community Medicine and Public Health Aponte R et al. Int J Community Med Public Health. 2022 Jun;9(6):2696-2700 http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040 Short Communication Long COVID-19 and achalasia: a possible relationship? Raúl Aponte 1 *, Nefertiti Daulabani 1 , Rosargelis Parra 1 , Luis Pérez-Ybarra 2 INTRODUCTION Achalasia is a motor disorder of the esophagus caused by loss or diminution of myenteric plexus neurons in the distal esophagus and lower esophageal sphincter (LES), producing aperistalsis and failure of the sphincter to relax. Symptoms include dysphagia, food regurgitation, chest pain, and weight loss. 1 Worldwide prevalence is 10 cases per 100 000 inhabitants, with an annual incidence of one new case per 100 000 inhabitants. 1 Esophageal motility is complex, involving extrinsic innervation and local reflex arcs, where in addition to classic excitatory neurotransmitters such as acetylcholine, and inhibitors such as intestinal vasopeptide and nitric oxide, there are several co-transmitters such as the Renin- Angiotensin System (RAS) in the distal esophagus musculature and Angiotensin II (AII) as a powerful stimulator of esophageal contractions through the ATR1 receptor (angiotensin 1 receptor), suggesting AII participates in the control of esophageal motor activity. 2 Angiotensin converting enzyme (ACE) is found in the capillary walls located at the apex of the papillae and in the blood vessel walls of the lamina propria of the distal esophagus. 3 SARS-CoV-2 virus is a single-stranded virus (β coronavirus). It enters host cells through the angiotensin- converting enzyme-2 (ACE2) receptor. Once inside, it undergoes replication and maturation, causing an inflammatory response with activation and infiltration of immune cells by various cytokines. 3 ACE2 receptor is present on numerous cell types throughout the human body, including oral cavity, nasal cavity, lungs, heart, esophageal epithelial cells, gastric glandular cells, enterocytes, liver, kidneys, spleen, brain, arterial and ABSTRACT 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. Keywords: Esophageal achalasia, COVID-19, SARS-CoV-2 infection 1 Clínica Gastro Bariátrica. Maracay, Aragua, Venezuela 2 Universidad de Carabobo. Facultad de Ciencias de la Salud. Maracay, Aragua, Venezuela Received: 08 April 2022 Accepted: 02 May 2022 *Correspondence: Dr. Raúl Aponte, E-mail: raulaponterendon@hotmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20221555