Gastroesophageal reflux disease in lung transplant patients with cystic fibrosis

Mendez, Bernardino M.; Davis, Christopher S.; Weber, Cynthia E.; Joehl, Raymond J.; Fisichella, P. Marco

doi:10.1016/j.amjsurg.2012.07.019

Cited by 45 publications

(29 citation statements)

References 30 publications

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“…The 5 year survival rates following LT for CF is approximately 60% 8. Patients with LT with CF have higher rates of GERD (90% vs 54% in non-CF controls), and, consequently, the risk of EAC for LT and CF is likely to be cumulative 5. In addition to severe and chronic GERD, inflammation secondary to inadequate pancreatic secretions, high concentrations of bile acids and exposure to exogenous pancreatic enzymes may also be contributory 1.…”

Section: Discussionmentioning

confidence: 99%

Successful surgical management of early esophageal cancer in a patient with cystic fibrosis post-bilateral lung transplantation

Walsh¹,

Maphango

Egan

et al. 2015

BMJ Case Reports

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We present the first reported case of successful surgical management of esophageal cancer post-lung transplantation for cystic fibrosis. This case of a 42-year-old man highlights the risk factors for esophageal adenocarcinoma associated with cystic fibrosis and lung transplantation, the management options for early esophageal cancer and the surgical option chosen to minimise respiratory risks. Individualised patient care may allow for curative surgical approaches, even where complex surgery is required.

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Section: Discussionmentioning

confidence: 99%

Successful surgical management of early esophageal cancer in a patient with cystic fibrosis post-bilateral lung transplantation

Walsh¹,

Maphango

Egan

et al. 2015

BMJ Case Reports

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“…Lung transplant patients were referred to the swallowing center at our institution for esophageal function testing, which was performed as previously described [24]. These patients were referred for esophageal function testing when GERD was clinically suspected and, most commonly, as early as possible after lung transplantation.…”

Section: Methodsmentioning

confidence: 99%

“…Nuclear medicine gastric emptying studies were performed by obtaining dynamic scintigraphic images through the abdomen for 90 min after oral administration of 0.4 mCi technetium-99m-labeled sulfur colloid in ovalbumin. Gastric emptying was considered delayed if < 30% of the gastric contents had emptied into the small bowel within 90 min [24]. …”

Section: Methodsmentioning

confidence: 99%

Pepsin concentrations are elevated in the bronchoalveolar lavage fluid of patients with idiopathic pulmonary fibrosis after lung transplantation

Davis¹,

Mendez²,

Flint³

et al. 2013

Journal of Surgical Research

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Background Aspiration of gastroesophageal refluxate has been implicated in the pathogenesis of idiopathic pulmonary fibrosis (IPF) and the progression of bronchiolitis obliterans syndrome after lung transplantation. The goals of the present study were to identify lung transplant patients at the greatest risk of aspiration and to investigate the causative factors. Materials and methods From September 2009 to November 2011, 252 bronchoalveolar lavage fluid (BALF) samples were collected from 100 lung transplant patients. The BALF pepsin concentrations and the results of transbronchial biopsy, esophageal function testing, barium swallow, and gastric emptying scan were compared among those with the most common end-stage lung diseases requiring lung transplantation: IPF, chronic obstructive pulmonary disease, cystic fibrosis, and α1-antitrypsin deficiency. Results Patients with IPF had higher BALF pepsin concentrations and a greater frequency of acute rejection than those with α1-antitrypsin deficiency, cystic fibrosis, or chronic obstructive pulmonary disease (P = 0.037). Moreover, the BALF pepsin concentrations correlated negatively with a lower esophageal sphincter pressure and distal esophageal amplitude; negatively with distal esophageal amplitude and positively with total esophageal acid time, longest reflux episode, and DeMeester score in those with chronic obstructive pulmonary disease; and negatively with the upright acid clearance time in those with IPF. Conclusions Our results suggest that patients with IPF after lung transplantation are at increased risk of aspiration and a greater frequency of acute rejection episodes, and that the risk factors for aspiration might be different among those with the most common end-stage lung diseases who have undergone lung transplantation. These results support the role of evaluating the BALF for markers of aspiration in assessing lung transplant patients as candidates for antireflux surgery.

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“…Gastrointestinal disorders in LTR include GORD, which is relatively prevalent pre-transplant in many patient groups and has been linked to post-transplant lung function decline [235,297,[313][314][315][316][317][318][319]. Although the observed association between GORD and CLAD is often difficult to separate in terms of cause and effect in later stages, if there is any evidence that GORD may be contributing to early loss of lung function, then appropriate medical and/or surgical therapies should be aggressively pursued [313,[320][321][322][323].…”

Section: Update On Lung Transplantationmentioning

confidence: 99%

Update on lung transplantation: programmes, patients and prospects

Kotsimbos¹,

Williams²,

Anderson³

2012

European Respiratory Review

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Gastroesophageal reflux disease in lung transplant patients with cystic fibrosis

Cited by 45 publications

References 30 publications

Successful surgical management of early esophageal cancer in a patient with cystic fibrosis post-bilateral lung transplantation

Successful surgical management of early esophageal cancer in a patient with cystic fibrosis post-bilateral lung transplantation

Pepsin concentrations are elevated in the bronchoalveolar lavage fluid of patients with idiopathic pulmonary fibrosis after lung transplantation

Update on lung transplantation: programmes, patients and prospects

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