{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T09:10:42Z","timestamp":1781341842151,"version":"3.54.1"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T00:00:00Z","timestamp":1669939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Achalasia is an autoimmune disease whose probable causal agent is a neurotropic virus that chronically infects the myenteric plexus of the esophagus and induces the disease in a genetically susceptible host. The association between achalasia and coronaviruses has not been reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate the presence of the SARS\u2010CoV\u20102 virus, the ACE2 expression, the tissue architecture, and immune response in the lower esophageal sphincter muscle (LESm) of achalasia patients who posteriorly had SARS\u2010CoV\u20102 (achalasia\u2010COVID\u201019) infection before laparoscopic Heller myotomy (LHM) and compare the findings with type II achalasia patients and transplant donors (controls) without COVID\u201019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The LESm of 7 achalasia\u2010COVID\u201019 patients (diagnosed by PCR), ten achalasia patients, and ten controls without COVID\u201019 were included. The presence of the virus was evaluated by in situ\n                      <jats:italic>PCR<\/jats:italic>\n                      and immunohistochemistry. ACE2 receptor expression and effector CD4 T cell and regulatory subsets were determined by immunohistochemistry.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>Coronavirus was detected in 6\/7 patients\u2010COVID\u201019. The SARS\u2010CoV\u20102 was undetectable in the LESm of the achalasia patients and controls. ACE2 receptor was expressed in all the patients and controls. One patient developed achalasia type II post\u2010COVID\u201019. The percentage of Th22\/Th17\/Th1\/pDCreg was higher in achalasia and achalasia\u2010COVID\u201019 pre\u2010HLM vs. controls. The Th2\/Treg\/Breg cell percentages were higher only in achalasia vs. controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion &amp; Inferences<\/jats:title>\n                    <jats:p>SARS\u2010CoV2 and its receptor expression in the LESm of achalasia patients who posteriorly had COVID\u201019 but not in the controls suggests that it could affect the myenteric plexus. Unlike achalasia, patients\u2010COVID\u201019 have an imbalance between effector CD4 T cells and the regulatory mechanisms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.14502","type":"journal-article","created":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T06:03:04Z","timestamp":1669960984000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Is the Sars\u2010CoV\u20102 virus a possible trigger agent for the development of achalasia?"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5804-7221","authenticated-orcid":false,"given":"Janette","family":"Furuzawa\u2010Carballeda","sequence":"first","affiliation":[{"name":"Department of Immunology and Rheumatology Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Ciudad de Mexico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda E.","family":"Icaza\u2010Ch\u00e1vez","sequence":"additional","affiliation":[{"name":"Hospital Faro del Mayab Christus Muguerza M\u00e9rida Yucat\u00e1n  Yucat\u00e1n Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9667-0022","authenticated-orcid":false,"given":"Diana","family":"Aguilar\u2010Le\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Pathologhy Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Ciudad de Mexico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norma","family":"Uribe\u2010Uribe","sequence":"additional","affiliation":[{"name":"Department of Pathologhy Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Ciudad de Mexico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda C.","family":"Nu\u00f1ez\u2010Pompa","sequence":"additional","affiliation":[{"name":"Department of Immunology and Rheumatology Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Ciudad de Mexico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alonso","family":"Trigos\u2010D\u00edaz","sequence":"additional","affiliation":[{"name":"Departments of Experimental Surgery and Surgery Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Ciudad de Mexico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"Are\u00e1n\u2010Sanz","sequence":"additional","affiliation":[{"name":"Departments of Experimental Surgery and Surgery Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Ciudad de Mexico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dheni A.","family":"Fern\u00e1ndez\u2010Camargo","sequence":"additional","affiliation":[{"name":"PECEM (MD\/PhD program), Facultad de Medicina Universidad Nacional Aut\u00f3noma de M\u00e9xico  Mexico City Mexico"},{"name":"Department of Nephrology and Mineral Metabolism Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Ciudad de Mexico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8569-2792","authenticated-orcid":false,"given":"Enrique","family":"Coss\u2010Adame","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Ciudad de Mexico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6676-1433","authenticated-orcid":false,"given":"Miguel A.","family":"Valdovinos","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Ciudad de Mexico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Brice\u00f1o\u2010Souza","sequence":"additional","affiliation":[{"name":"Department of Immunology and Rheumatology Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Ciudad de Mexico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3335-8178","authenticated-orcid":false,"given":"Luis A.","family":"Chi\u2010Cervera","sequence":"additional","affiliation":[{"name":"Hospital Faro del Mayab Christus Muguerza M\u00e9rida Yucat\u00e1n  Yucat\u00e1n Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Olivares\u2010Flores","sequence":"additional","affiliation":[{"name":"Department of Pathologhy Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Ciudad de Mexico 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