Lung Transplantation Exacerbates Gastroesophageal Reflux Disease *

Young, Lisa R.; Hadjiliadis, Denis; Davis, Robert D.; Palmer, Scott M.

doi:10.1378/chest.124.5.1689

Cited by 202 publications

(151 citation statements)

References 21 publications

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“…(17) The correlation between symptoms and reflux in lung transplant candidates has been described in 42% of the symptomatic patients and in 14% of the asymptomatic patients. (10,14) As in another study, (5) our sample revealed no association between reflux and abnormal esophageal manometry in patients with advanced lung disease. Other respiratory manifestations can also be accompanied by esophageal dysmotility.…”

Section: Discussionsupporting

confidence: 65%

“…Recent studies have demonstrated improvement in pulmonary function in patients with BOS who were submitted to fundoplication, thereby rousing interest in evaluating GER as a possible causal agent of BOS. (2,(4)(5)(6) Given the need to obtain data on the presence of GER in lung transplant candidates in Brazil, this study assessed the prevalence and characteristics of GER in lung transplant candidates, correlating the findings of 24-h esophageal pH-metry with those of the evaluation of esophageal function by esophageal manometry. Based on these data, further studies will be designed in order to evaluate the incidence of post-transplant reflux, as well as its potential association with late graft dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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Prevalência de refluxo gastroesofágico em pacientes com doença pulmonar avançada candidatos a transplante pulmonar

et al. 2008

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Objective: To assess the esophageal function profile and the prevalence of gastroesophageal reflux (GER) in lung transplant candidates. Methods: From July of 2005 to November of 2006, a prospective study was conducted involving 55 candidates for lung transplantation at the Santa Casa de Misericórdia Hospital in Porto Alegre, Brazil. Prior to transplantation, patients underwent outpatient stationary esophageal manometry and 24-h esophageal pH-metry using one and two electrodes. Results: Abnormal esophageal manometry was documented in 80% of the patients, and 24% of the patients presented pathological acid reflux. Digestive symptoms presented sensitivity and specificity for GER of 50% and 61%, respectively. Of the patients with chronic obstructive pulmonary disease, 94% presented abnormal esophageal manometry, and 80% presented lower esophageal sphincter hypotonia, making it the most common finding. Patients with bronchiectasis presented the highest prevalence of GER (50%). Conclusions: In patients with advanced lung disease, GER is highly prevalent. In the population studied, digestive symptoms of GER were not predictive of pathological acid reflux. The role that GER plays in chronic rejection should be examined and clarified in future studies.Keywords: Gastroesophageal reflux; Lung transplantation; Manometry; Esophageal pH monitoring. ResumoObjetivo: Avaliar o perfil funcional do esôfago e a prevalência de refluxo gastroesofágico (RGE) em pacientes candidatos a transplante pulmonar. Métodos: Foram analisados prospectivamente, entre junho de 2005 e novembro de 2006, 55 pacientes candidatos a transplante pulmonar da Santa Casa de Misericórdia de Porto Alegre. Os pacientes foram submetidos a esofagomanometria estacionária e pHmetria esofágica ambulatorial de 24 h de um e dois eletrodos antes de serem submetidos ao transplante pulmonar. Resultados: A esofagomanometria foi anormal em 80% dos pacientes e a pHmetria revelou RGE ácido patológico em 24%. Os sintomas digestivos apresentaram sensibilidade de 50% e especificidade de 61% para RGE. Dos pacientes com doença pulmonar obstrutiva crônica, 94% apresentaram alteração à manometria, e 80% apresentaram hipotonia do esfíncter inferior, que foi o achado mais freqüente. Pacientes com bronquiectasias apresentaram a maior prevalência de RGE (50%). Conclusões: O achado freqüente em pacientes com doença pulmonar avançada é RGE. Na população examinada, a presença de sintomas digestivos de RGE não foi preditiva de refluxo ácido patológico. A contribuição do RGE na rejeição crônica deve ser considerada e requer estudos posteriores para seu esclarecimento.Descritores: Refluxo gastroesofágico; Transplante de pulmão; Manometria; Monitoramento do pH esofágico.* Study carried out in the

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Prevalência de refluxo gastroesofágico em pacientes com doença pulmonar avançada candidatos a transplante pulmonar

et al. 2008

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“…In contrast, patients with severe lung disease often have unrecognised pathological reflux. In one study of 65 consecutive IPF patients, 87% had pathological gastro-oesophageal reflux (GER) [12], another study reported GERD in 48-76% of patients following lung transplantation [13][14][15]. Microaspiration is more likely in the setting of impaired swallowing mechanism and depressed alertness, conditions more prevalent in the elderly, as suggested by one study [16] which showed an association of bilateral chest radiography scarring with pH probe-proven GERD in elderly patients referred for evaluation of gastrointestinal symptoms.…”

Section: Definition and Epidemiologymentioning

confidence: 99%

“…BOS manifests clinically as progressive dyspnoea, cough and recurrent infection, with the characteristic finding of progressive airflow limitation on pulmonary function testing. It has been increasingly recognised that GERD, present in 48-76% of patients post-transplantation [13][14][15], may be a key factor in the development and progression of BOS [80]. Factors predisposing to GERD-related lung disease in this population include gastroparesis [81], vagus nerve dysfunction, a high incidence of post-operative oropharyngeal dysphagia [82], and depressed cough reflex due to the lack of innervation of the allograft [83].…”

Section: Bronchiolitis Obliterans In Lung Transplant Recipientsmentioning

confidence: 99%

“…Factors predisposing to GERD-related lung disease in this population include gastroparesis [81], vagus nerve dysfunction, a high incidence of post-operative oropharyngeal dysphagia [82], and depressed cough reflex due to the lack of innervation of the allograft [83]. Most lung transplant patients with GERD lack classic symptoms [14], and although acid suppression therapy is frequently given to this patient group, non-acid reflux is present in up to 50% as documented by the finding of bile acids in lung lavage samples [13], a finding associated with BOS in one study [84]. Supporting the aetiological role of GERD in a subset of BOS patients, DAVIS et al [85] NTM infection NTM infection of the lung may produce a clinical picture of nodular bronchiectasis in nonsmokers [86], and this disease has been associated with oesophageal disorders [87][88][89].…”

Section: Bronchiolitis Obliterans In Lung Transplant Recipientsmentioning

confidence: 99%

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Gastro-oesophageal reflux disease and non-asthma lung disease

Morehead¹

2009

European Respiratory Review

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Gastro-oesophageal reflux disease (GERD) is a common disorder in Western countries, and its relationship to airways disorders (e.g. asthma) has been well established. Lung diseases other than asthma have also been associated with GERD, but the nature and scope of this relationship has not been fully defined. Diseases that have been associated with GERD include bronchiolitis syndromes, idiopathic pulmonary fibrosis, scleroderma and nontubercular mycobacterial infection.Diagnostic evaluation centres upon proving both reflux and pulmonary aspiration, which may be accomplished in some cases by lung biopsy. However, in many cases a compatible clinical and radiographic picture coupled with proof of proximal reflux by combined oesophageal probe testing may suffice for a provisional diagnosis and allow institution of anti-reflux measures.Proton-pump inhibitors are the medications of choice for GERD; other interventions shown to reduce reflux are weight loss, elevation of the head of the bed and avoidance of recumbency after meals. However, acid suppression therapy does not address non-acid reflux that may be important in disease pathogenesis in select patients, and lifestyle modifications often fail.Laparoscopic fundoplication is the procedure of choice for medically refractory GERD with excellent short-term results with respect to respiratory symptoms associated with GERD; however, long-term studies document a significant percentage of patients requiring ongoing acid suppression therapy.

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Patient Selection and Indications for Lung Transplantation

Garrity

2014

Textbook of Organ Transplantation

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Lung Transplantation Exacerbates Gastroesophageal Reflux Disease *

Cited by 202 publications

References 21 publications

Prevalência de refluxo gastroesofágico em pacientes com doença pulmonar avançada candidatos a transplante pulmonar

Prevalência de refluxo gastroesofágico em pacientes com doença pulmonar avançada candidatos a transplante pulmonar

Gastro-oesophageal reflux disease and non-asthma lung disease

Patient Selection and Indications for Lung Transplantation

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