A small number of gastroparesis cases have been reported after presumed viral illness. Patients developed nausea, vomiting, and bloating immediately or several months after onset of viral infection. Gastric emptying study confirms delayed gastric emptying or gastroparesis. Management relies on pro-motility and anti-nausea medications. However, when symptoms persist, an antrum preserving partial gastrectomy is indicated to restore normal gastric emptying and improve quality of life.
Since the onset of COVID-19 pandemic, we have encountered one case of gastroparesis flare-up and one case of new onset gastroparesis and esophageal dysmotility immediately following COVID-19 infection.
The first case is a 22-year-old female with a 4-year history of idiopathic gastroparesis managed with medications. The patient developed acute onset cough, sore throat, and shortness of breath. She tested positive for COVID-19. She concomitantly experienced worsening nausea, vomiting, and abdominal pain. She was initially managed at home, but her respiratory symptoms got worse, and she was admitted to hospital. For 6 months, the patient struggled with worsening nausea and vomiting despite the resolution of her respiratory symptoms. Repeat gastric emptying study confirmed worsening gastroparesis. The patient’s inability to tolerate regular diet and significant weight loss necessitated placement of a feeding tube. Upon presentation to Houston Heartburn and reflux Center, the patient was dependent on tube feeding and narcotics for abdominal pain control. Her weight has stabilized, and she was tolerating a minimal amount of soft food.
The patient underwent an antrum preserving longitudinal gastrectomy with no complications. Her recovery was fast, and her gastroparesis symptoms resolved immediately following surgery. Repeat gastric emptying study 2 months after surgery showed normal gastric emptying rate.
The second case is a 63-year-old female who presented with new onset difficulty swallowing, bloating, nausea, and dry heaving 2 years after hiatal hernia repair and Nissen fundoplication. Patient concomitantly developed these symptoms along with high fever, sore throat, and cough. She tested positive for COVID. She was managed conservatively at home. In two weeks, her viral infection and respiratory symptoms resolved. Nausea, bloating, early satiety, and difficulty swallowing persisted. Upper endoscopy showed intact Nissen fundoplication and no evidence of recurrent hiatal hernia or acid reflux. Gastric emptying study revealed delayed gastric emptying. Manometry was ordered. The patient was started on Reglan and gastroparesis friendly diet. We think COVID-19 infection damaged esophageal and stomach nerves, leading to decreased motility. We don’t know yet whether this damage is transient or permanent.