Evolving Concepts Regarding Hiatal Hernia and Gastroesophageal Reflux

Davis, Milton V.

doi:10.1016/s0003-4975(10)66156-5

Cited by 30 publications

(9 citation statements)

References 7 publications

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“…calcineurin inhibitors) or iatrogenic vagal nerve injury at surgery or it may even be present as a preoperative condition. In fact, interstitial lung disease secondary to connective tissue disorders, idiopathic pulmonary fibrosis and cystic fibrosis have all been associated with GER (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). We have previously documented the association between BOS and bile acid aspiration along with the association between alveolar neutrophilia and IL-8.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Reflux and Bile Acid Aspiration on the Lung Allograft and Its Surfactant and Innate Immunity Molecules SP-A and SP-D

D’Ovidio

Mura

Ridsdale

et al. 2006

American Journal of Transplantation

171

116

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Gastro-esophageal reflux and related pulmonary bile acid aspiration were prospectively investigated as possible contributors to postlung transplant bronchiolitis obliterans syndrome (BOS). We also studied the impact of aspiration on pulmonary surfactant collectin proteins SP-A and SP-D and on surfactant phospholipids-all important components of innate immunity in the lung. Proximal and distal esophageal 24-h pH testing and broncho-alveolar lavage fluid (BALF) bile acid assays were performed prospectively at 3-month posttransplant in 50 patients. BALF was also assayed for SP-A, SP-D and phospholipids expressed as ratio to total lipids: phosphatidylcholine; dipalmitoylphosphatidylcholine; phosphatidylglycerol (PG); phosphatidylinositol; sphingomyelin (SM) and lysophosphatidylcholine. Actuarial freedom from BOS was assessed.Freedom from BOS was reduced in patients with abnormal (proximal and/or distal) esophageal pH findings or BALF bile acids (Log-rank Mantel-Cox p < 0.05). Abnormal pH findings were observed in 72% (8 of 11) of patients with bile acids detected within the BALF. BALF with high levels of bile acids also had significantly lower SP-A, SP-D, dipalmitoylphosphatidylcholine; PG and higher SM levels (Mann-Whitney, p < 0.05). Duodeno-gastro-esophageal reflux and consequent aspiration is a risk factor for the development of BOS postlung transplant. Bile acid aspiration is associated with impaired lung allograft innate immunity manifest by reduced surfactant collectins and altered phospholipids.

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Section: Introductionmentioning

confidence: 99%

The Effect of Reflux and Bile Acid Aspiration on the Lung Allograft and Its Surfactant and Innate Immunity Molecules SP-A and SP-D

D’Ovidio

Mura

Ridsdale

et al. 2006

American Journal of Transplantation

171

116

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“…The commonality between GER and respiratory diseases, such as asthma, cystic fibrosis, and IPF, has been well studied over the course of decades (15–19). Likewise, the increased prevalence of GER in the lung transplant population has been recently characterized.…”

Section: From Ger To Aspirationmentioning

confidence: 99%

A review of the potential applications and controversies of non‐invasive testing for biomarkers of aspiration in the lung transplant population

Davis¹,

Gagermeier

Dilling

et al. 2010

Clinical Transplantation

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Despite improvements in one-yr survival following lung transplantation, five-yr survival lags significantly behind the transplantation of other solid organs. The contrast in survival persists despite advancements in anti-rejection regimens, suggesting a non-alloimmune mechanism to chronic lung transplant failure. Notably, markers of aspiration have been demonstrated in bronchoalveolar lavage (BAL) fluid concurrent with bronchiolitis obliterans syndrome (BOS). This recent evidence has underscored gastro-esophageal reflux (GER) and its associated aspiration risk as a non-alloimmune mechanism of chronic lung transplant failure. Given the suggested safety and efficacy of laparoscopic anti-reflux procedures in the lung transplant population, identifying those at risk for aspiration is of prime importance, especially concerning the potential for long-term improvements in morbidity and mortality. Conventional diagnostic methods for GER and aspiration, such as pH monitoring and detecting pepsin and bile salts in BAL fluid, have gaps in their effectiveness. Therefore, we review the applications and controversies of a non-invasive method of defining reflux injury in the lung transplant population: the detection of biomarkers of aspiration in the exhaled breath condensate. Only by means of assay standardization and directed collaboration may such a non-invasive method be a realization in lung transplantation.

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“…There is evidence that oesophageal reflux may exacerbate asthma through cholinergic mechanisms, because anticholinergic drugs inhibit the bronchoconstriction associated with reflux 96 . Treatment with cimetidine and surgical correction of the gastro‐oesophageal sphincter reflux have been shown to improve nocturnal symptoms of asthma 91‐93,97 …”

Section: Gastro‐oesophageal Refluxmentioning

confidence: 99%

Chronobiology and Chronopathophysiology of Nocturnal Asthma

Syabbalo

1997

Int J Clinical Practice

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SUMMARYAsthma is increasing in prevalence and severity worldwide despite effective treatment and innovative research developments. Chronobiology is the study of biological rhythms and their mechanisms. Asthma is one of many diseases that exemplifies a circadian pattern in intensity, frequency of attacks and mortality. As many as 90% of asthmatics experience nocturnal symptoms severe enough to awaken them from sleep. Increased airway narrowing at night is thought to occur as a result of circadian variation in neurohormones and intensification of airway inflammation. Furthermore, vagal tone, neurogenic inflammation and airway hyperresponsiveness are increased at night. Many cells contribute to the nocturnal inflammatory process in the asthmatic airways, including mast cells, eosinophils, neutrophils and lymphocytes. These cells are capable of secreting innumerable inflammatory mediators, such as histamine, cytokines, leukotrienes, prostaglandins, neutral endopeptidase and superoxides, which are potent bronchoconstrictors and secretogogues. They also cause increased vascular permeability and airway oedema. All these chronobiological events promote nocturnal worsening of asthma and increased nocturnal deaths. Understanding the mechanisms of nocturnal asthma will help us learn more about asthma, and how to implement appropriate chronotherapeutic interventions.

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Evolving Concepts Regarding Hiatal Hernia and Gastroesophageal Reflux

Cited by 30 publications

References 7 publications

The Effect of Reflux and Bile Acid Aspiration on the Lung Allograft and Its Surfactant and Innate Immunity Molecules SP-A and SP-D

The Effect of Reflux and Bile Acid Aspiration on the Lung Allograft and Its Surfactant and Innate Immunity Molecules SP-A and SP-D

A review of the potential applications and controversies of non‐invasive testing for biomarkers of aspiration in the lung transplant population

Chronobiology and Chronopathophysiology of Nocturnal Asthma

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