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SARS-CoV-2 may activate TLR4 in the heart and lungs causing aberrant TLR4 signaling favoring the proinflammatory MyD88-dependent (canonical) pathway instead of the alternative TRIF/TRAM-dependent anti-inflammatory and interferon pathway (Aboudounya and Heads, 2021)
For patients with persistent reflux symptoms despite 8 weeks of PPI therapy or those with alarm features, referral to gastroenterology for upper endoscopy may be warranted, consistent with American College of Gastroenterology guidelines
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