Gastroesophageal Reflux and Esophageal Motility Disorder After Lung Transplant: Influence on the Transplanted Graft

Pablo, Alicia de; Alonso, Raquel Cano; Ciriza, C; López, E.; Canga, F; Juarros, Lourdes; Gámez, Pablo; Pérez, Virginia

doi:10.1016/j.transproceed.2021.03.035

Cited by 5 publications

(5 citation statements)

References 36 publications

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“…1,2 Esophageal dysmotility and gastroesophageal reflux (GER) are common in patients with respiratory disease, thought to be linked to disease progression, and are also common following LTx. The most common esophageal motor disorders include minor disorders of peristalsis, such as ineffective esophageal motility (IEM) and esophago-gastric junction outflow obstruction (EGJOO), [3][4][5][6][7][8][9] along with Jackhammer esophagus seen in some patients, mainly post-LTx, 4,[6][7][8][10][11][12] IEM is associated with greater numbers of proximal reflux events both in respiratory disease 9 and following LTx, 8 while EGJOO is associated with significantly less GER, despite an apparent increased risk of developing CLAD post-LTx. 8 Although studies have suggested that distal contractile integral (DCI) 4,6,7 and aperistalsis prior to LTx can improve following LTx, 13,14 it remains unclear whether certain motility diagnoses prior to LTx either remain the same or change to another diagnosis following LTx, and if this differs with type of respiratory disease.…”

Section: Introductionmentioning

confidence: 99%

The impact of lung transplantation on esophageal motility and inter‐relationships with reflux and lung mechanics in patients with restrictive and obstructive respiratory disease

Alghubari,

Cheah,

Z. Shah

et al. 2024

Neurogastroenterology Motil

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BackgroundFor many patients with lung disease the only proven intervention to improve survival and quality of life is lung transplantation (LTx). Esophageal dysmotility and gastroesophageal reflux (GER) are common in patients with respiratory disease, and often associate with worse prognosis following LTx. Which, if any patients, should be excluded from LTx based on esophageal concerns remains unclear. Our aim was to understand the effect of LTx on esophageal motility diagnosis and examine how this and the other physiological and mechanical factors relate to GER and clearance of boluses swallowed.MethodsWe prospectively recruited 62 patients with restrictive (RLD) and obstructive (OLD) lung disease (aged 33–75 years; 42 men) who underwent high resolution impedance manometry and 24‐h pH‐impedance before and after LTx.Key ResultsRLD patients with normal motility were more likely to remain normal (p = 0.02), or if having abnormal motility to change to normal (p = 0.07) post‐LTx than OLD patients. Esophageal length (EL) was greater in OLD than RLD patients' pre‐LTx (p < 0.001), reducing only in OLD patients' post‐LTx (p = 0.02). Reduced EL post‐LTx associated with greater contractile reserve (r = 0.735; p = 0.01) and increased likelihood of motility normalization (p = 0.10). Clearance of reflux improved (p = 0.01) and associated with increased mean nocturnal baseline impedance (p < 0.001) in RLD but not OLD. Peristaltic breaks and thoraco‐abdominal pressure gradient impact both esophageal clearance of reflux and boluses swallowed (p < 0.05).Conclusions and InferencesRLD patients are more likely to show improvement in esophageal motility than OLD patients post‐LTx. However, the effect on GER is more difficult to predict and requires other GI, anatomical and pulmonary factors to be taken into consideration.

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Section: Introductionmentioning

confidence: 99%

The impact of lung transplantation on esophageal motility and inter‐relationships with reflux and lung mechanics in patients with restrictive and obstructive respiratory disease

Alghubari,

Cheah,

Z. Shah

et al. 2024

Neurogastroenterology Motil

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“…We conducted a search in PubMed, from database inception to January 22, 2023, for reports in any language using the search terms ("lung transplant" OR "lung transplantation" ) AND ( "chronic rejection" OR "chronic lung allograft dysfunction" OR "bronchiolitis obliterans syndrome" OR "CLAD" OR "BOS" ) AND ("esophagus" OR "esophageal" OR "manometry" OR "achalasia" OR "EGJOO" OR "esophagogastric junction outflow obstruction" OR "esophageal motility"), which yielded 53 articles. Of these, only five studies (with 50 to 93 patients) assessed the relationship between post-lung transplant esophageal motility or function and any post-transplant outcomes (11)(12)(13)(14)(15). Of these five, three only investigated symptomatic patients (11,12,14), one did not use CLAD as an outcome (13), and the fifth, while assessing CLAD as an outcome, did not correct for possible confounding variables (15).…”

Section: Introductionmentioning

confidence: 99%

“…Of these, only five studies (with 50 to 93 patients) assessed the relationship between post-lung transplant esophageal motility or function and any post-transplant outcomes (11)(12)(13)(14)(15). Of these five, three only investigated symptomatic patients (11,12,14), one did not use CLAD as an outcome (13), and the fifth, while assessing CLAD as an outcome, did not correct for possible confounding variables (15). We therefore concluded that a larger study was needed to evaluate the association between esophageal disorders and CLAD in better powered multivariable models.…”

Section: Introductionmentioning

confidence: 99%

Oesophageal stasis is a risk factor for chronic lung allograft dysfunction and allograft failure in lung transplant recipients

Ramendra,

Fernández-Castillo,

Huszti

et al. 2023

ERJ Open Res

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BackgroundMorbidity and mortality in lung transplant recipients are often triggered by aspiration events, potentiated by esophageal and gastric disorders. Previous small studies have shown conflicting associations between esophageal function and the development of chronic lung allograft dysfunction (CLAD). Herein, we sought to investigate the relationship between esophageal motility disorders and long-term outcomes in a large retrospective cohort of lung transplant recipients.MethodsAll lung transplant recipients at the Toronto Lung Transplant Program from 2012–2018 with available esophageal manometry testing within the first 7 months post-transplant were included in this study. Patients were categorized according to the esophageal disorders Chicago classification system v3.0. Associations between esophageal motility disorders with the development of CLAD and allograft failure (defined as death or retransplantation) were assessed.ResultsOf 487 patients, 57 (12%) had esophagogastric junction outflow obstruction (EGJOO) and 47 (10%) had a disorder of peristalsis (8 major, 39 minor). In a multivariable analysis, EGJOO was associated with an increased risk of CLAD [HR=1.71 (1.15–2.55); p=0.008] and allograft failure [HR=1.69 (1.13–2.53); p=0.01]. Major disorder of peristalsis was associated with an increased risk of CLAD [HR=1.55 (1.01–2.37); p=0.04] and allograft failure [HR=3.33 (1.53–7.25); p=0.002]. Minor disorder of peristalsis was not significantly associated with CLAD or allograft failure.ConclusionLung transplant recipients with esophageal stasis characterized by EGJOO or major disorder of peristalsis were at an increased risk of adverse long-term outcomes. These findings will help with risk stratification of lung transplant recipients and personalization of treatment for aspiration prevention.

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confidence: 99%

“…3 AZI diminishes interleukin (IL)-17 stimulated production of IL-8 in human airway smooth muscle cells, reduces other cytokines, and promotes gut motility, all of which may reduce CLAD development. [4][5][6] Multiple case series reported stabilization of lung function after AZI treatment for bronchiolitis obliterans syndrome (BOS). In these recipients, increased neutrophils in bronchoalveolar lavage (BAL) fluid, were associated with recovery following AZI therapy, leading to the distinction between neutrophilic reversible allograft dysfunction and fibroproliferative.…”

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confidence: 99%

Decreased Lymphocytic Bronchitis Severity in the Era of Azithromycin Prophylaxis

Santos,

Hays,

Golden

et al. 2023

Transplantation Direct

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Background. Large-airway lymphocytic inflammation (LB), assessed on endobronchial biopsies, has been associated with acute cellular rejection and chronic lung allograft dysfunction (CLAD). Azithromycin (AZI) prophylaxis has been used to prevent airway inflammation and subsequent CLAD, with inconsistent results. We hypothesized that AZI prophylaxis would be associated with reduced LB, changes in bronchoalveolar lavage (BAL) immune cell populations, and improved CLAD-free survival. Methods. We compared frequencies of LB from endobronchial biopsies before (N = 1856) and after (N = 975) protocolized initiation of AZI prophylaxis at our center. LB was classified as none, minimal, mild, or moderate by histopathologic analysis. LB grades were compared using ordinal mixed-model regression. Corresponding automated BAL leukocyte frequencies were compared using mixed-effects modeling. The effect of AZI prophylaxis on CLAD-free survival was assessed by a Cox proportional hazards model adjusted for age, sex, ethnicity, transplant indication, and cytomegalovirus serostatus. Results. Biopsies in the pre-AZI era had 2-fold increased odds (95% confidence interval, 1.5-2.7; P < 0.001) of higher LB grades. LB was associated with BAL neutrophilia in both eras. However, there was no difference in risk for CLAD or death between AZI eras (hazard ratio 1.3; 95% confidence interval, 0.7-2.0; P = 0.45). Conclusions. Decreased airway inflammation in the era of AZI prophylaxis may represent a direct effect of AZI therapy or reflect other practices or environmental changes. In this cohort, AZI prophylaxis was not associated with improved CLAD-free survival.

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Gastroesophageal Reflux and Esophageal Motility Disorder After Lung Transplant: Influence on the Transplanted Graft

Cited by 5 publications

References 36 publications

The impact of lung transplantation on esophageal motility and inter‐relationships with reflux and lung mechanics in patients with restrictive and obstructive respiratory disease

The impact of lung transplantation on esophageal motility and inter‐relationships with reflux and lung mechanics in patients with restrictive and obstructive respiratory disease

Oesophageal stasis is a risk factor for chronic lung allograft dysfunction and allograft failure in lung transplant recipients

Decreased Lymphocytic Bronchitis Severity in the Era of Azithromycin Prophylaxis

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