Esophageal contractility increases and gastroesophageal reflux does not worsen after lung transplantation

Abstract

SUMMARY Gastroesophageal reflux and esophageal dysmotility are common in patients with advanced lung disease and are associated with allograft dysfunction after lung transplantation. The effect of transplantation on reflux and esophageal motility is unclear. The aim of this study was to describe the changes in esophageal function occurring after lung transplantation. A retrospective cohort study was performed on lung transplant candidates evaluated at a tertiary care center between 2015 and 2016. A total of 76 patients who underwent lung transplantation had high-resolution manometry and ambulatory pH-metry before and after transplant. Demographic data, esophageal function testing results, and clinical outcomes such as pulmonary function testing were collected and analyzed using appropriate statistical tests and multivariable regression. Of the 76 patients, 59 (78%) received a bilateral transplant. There was a significant increase in esophageal contractility posttransplant, with an increase in median distal contractile integral from 1470 to 2549 mmHg cm s (P < 0.01). There were 19 patients with Jackhammer esophagus posttransplant, including 15 patients with normal motility pretransplant. Nine patients with ineffective or fragmented peristalsis pretransplant had normal manometry posttransplant. Abnormal pH-metry was observed in 35 (46%) patients pretransplant and 29 (38%) patients posttransplant (P = 0.33). Patients with gastroesophageal reflux disease posttransplant had less improvement in pulmonary function at one year, as measured by forced expiratory volume (P = 0.04). These results demonstrate that esophageal contractility increases significantly after lung transplantation, with an associated change in motility classification. In comparison, gastroesophageal reflux does not worsen, but is associated with worse pulmonary function, posttransplant.

Jackhammer esophagus: A meta‐analysis of patient demographics, disease presentation, high‐resolution manometry data, and treatment outcomes

“…We found four studies reporting the specific prevalence of JE in morbidly obese patients or patients undergoing evaluation for bariatric surgery, 34‐37 six in patients with systemic sclerosis 38‐43 and four in postlung transplant patients 44‐47 (Figure 3). When compared to the prevalence of JE in the unselected general symptomatic population referred for HRM, diagnoses of JE were significantly more frequent in morbidly obese patients (5.18% [95% CI: 1.76%‐14.3%]; P = .009) and in postlung transplant patients undergoing HRM (23.99% [95% CI: 9.00%‐38.97%]; P < .001).…”

“…It is to be noted, however, that all four studies included on obese/prebariatric surgery patients and one study on systemic sclerosis patients were done on a strictly asymptomatic population undergoing HRM. Furthermore, in two of the studies reporting on JE in postlung transplant patients, 45,46 HRM was performed after transplant in all patients routinely, regardless of whether or not they were symptomatic. We found Kristo et al 34 to be an influential study and once excluded the prevalence of JE in obese patients was no longer statistically superior to the unselected general population (Table S2).…”

“…We found four studies reporting the specific prevalence of JE in morbidly obese patients or patients undergoing evaluation for bariatric surgery, [34][35][36][37] six in patients with systemic sclerosis [38][39][40][41][42][43] and four in postlung transplant patients [44][45][46][47] (Figure 3 of whether or not they were symptomatic. We found Kristo et al 34 to be an influential study and once excluded the prevalence of JE in obese patients was no longer statistically superior to the unselected general population (Table S2).…”

“…Thus, it is possible that esophageal hypercontractility peaks in Pooled clinical success rate of different treatment modalities for jackhammer esophagus dysmotility even before transplantation, there is a clear increase in esophageal motility disorders, including JE, after lung transplant 45,46. In Posner et al's study on 76 lung transplant patients,46 the median DCI increased from 1470 mm Hg•s•cm to 2549 mm Hg•s•cm after lung transplant and accordingly the number of diagnoses of JE increased from five (6.6%) to 19 (25.0%). The median IRP also increased from 7.0 to 10.2 mm Hg.…”

Esophageal disease in lung transplant patients

“…They did not see an increase in gastroesophageal reflux-35 (46%) of patients pre-transplant had an abnormal pH study compared with 29 (38%) of patients post-transplant (P=0.33). That said, patients with GERD post-transplant had less improvement in their pulmonary function at one year as measured by forced expiratory volume over 1 second (FEV1) (P=0.04) (17).…”