Prevalence of gastrointestinal dysmotility and complications detected by abdominal plain films after lung transplantation: a single-centre cohort study

Abstract

Introduction and AimsGastrointestinal (GI) complications such as gastric retention (GR) and constipation are common after lung transplantation (LT). Abdominal plain films (APFs) are a low-cost diagnostic tool to detect impaired GI function. The goal of our study was to assess the prevalence of GI pathology seen on APF in lung transplant recipients (LTRs) and to identify associated risk factors.MethodsRetrospective analysis of consecutive LTRs followed up between 2001 and 2013. Demographic, radiographic and clinical data were assessed.Results198 patients were included in the study, 166 thereof had more than 1 APF with a mean number of 5 APFs per patient. 163 patients had a detectable radiographic pathology on APF. The proportion of LTR with GR was highest among cystic fibrosis patients (48.5%). Multivariate regression analysis showed a significant association of diabetes with GR with a trend for age and use of opiates as risk factors. Similarly, female sex, advanced age and diabetes showed a trend to be associated with lower GI tract complications. Almost all patients had suffered from at least 1 episode of lower GI dysmotility during a median follow-up of 5.7 years. No clear correlation between GI events and the development of chronic lung allograft dysfunction could be identified.ConclusionsWe found a statistically significant association of diabetes with GR and a progressive increase in the prevalence of GR over time after LT. Lower GI complications affected >80% of LTR and increased over time. Future studies correlating GI transit with APF findings are needed.

Lung transplantation delays gastric motility in patients without prior gastrointestinal surgery—A single‐center experience of 412 consecutive patients

“…Prior studies examining the prevalence of DGE following lung transplantation are quite varied, and discrepant, with reported ranges from 23% to 91% . The discrepancy in these studies is most notably due to their small sample size and in some instances, their DGE defining cut‐offs based on their respective, institution‐specific SGE study protocols . For example, Bodet‐Milin et al examined 30 patients and found that DGE was prevalent in 67% of patients pre‐lung transplant and 97% of patients post‐lung transplant, more frequently observed in patients with end‐stage CF.…”

“…For example, a recent study of 198 lung transplant recipients found a statistically significant association of diabetes with gastric retention, detected by abdominal plain films, and whose prevalence progressively increased over time following lung transplantation. Moreover, proportionally, almost half the patients had cystic fibrosis . In these contexts, it may be difficult to accurately assess the role of lung transplantation in the pathogenesis of DGE in these two specific populations.…”

“…Physiologic changes in the gastrointestinal (GI) tract following lung transplantation are common and can lead to various complications that have been associated with substantial morbidity and mortality . Furthermore, previous studies have demonstrated an association between gastro‐esophageal reflux disease (GERD) and the development of bronchiolitis obliterans syndrome (BOS), a form of chronic lung allograft dysfunction (CLAD) .…”

“…Existing literature describing the occurrence of DGE following lung transplantation is limited, varied and in some cases limited by sample sizes. 1,6,10,11 For instance, in examining 30 patients following lung transplantation, Bodet-Milin et al demonstrated that DGE was prevalent in 67% of patients pretransplant and 97% of patients post-transplant. 9 D'Ovidio et al, on the other hand, examined 36 patients but only found a 44% prevalence of DGE following lung transplantation.…”

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Physiologic changes in the gastrointestinal (GI) tract following lung transplantation are common and can lead to various complications that have been associated with substantial morbidity and mortality. [1][2][3][4][5][6] Furthermore, previous studies have demonstrated an association between gastro-esophageal reflux disease (GERD) and the development of bronchiolitis obliterans syndrome (BOS), a form of chronic lung allograft dysfunction (CLAD). 3,7 Delayed gastric emptying (DGE), another postoperative complication that has featured prominently in the lung transplantation literature, has been shown to increase the incidence of GERD, and perhaps may be indirectly responsible for CLAD.

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