The Intersection of GERD, Aspiration, and Lung Transplantation

Abstract

Lung transplantation is a radical but life-saving treatment option for patients with end-stage lung diseases, such as idiopathic pulmonary fibrosis (IPF) and scleroderma. In light of the proposed association and controversy linking gastroesophageal reflux disease (GERD) to IPF and lung transplant outcome, the American Gastroenterological Association convened during the DDW in Washington in May 2015 a multidisciplinary group of experts in the field of GERD and lung transplantation to make considerations about the care of these patients based on available data and subsequent expert panel discussion at this symposium. The following topics were discussed: (1) pathophysiology of GERD-induced pulmonary symptoms, (2) GERD evaluation before and after lung transplantation, (3) outcome of lung transplantation for IPF and scleroderma, and (4) role of laparoscopic fundoplication before or after lung transplantation.

Preoperative Gastroesophageal Reflux Disorder Is Associated With Increased Morbidity in Patients Undergoing Abdominal Surgery

“…The retrospective nature of the analysis limits the ability for randomization and increases potential for confounding. Although both cardiac (16–17) and respiratory (13–15) pathologies have been linked to GERD, we did not find a significant association between GERD and these complications. This was likely impacted by limited power and the low rate of these complication subtypes in our patient population.…”

“…GERD can be associated with respiratory pathologies such as asthma (13) as well as with intra- and post-operative aspiration in the setting of lung transplant (14, 15). Atrial fibrillation (16) and acute myocardial infarction (17) have also been linked to GERD.…”

Systemic Sclerosis Associated Interstitial Lung Disease: A Comprehensive Overview

“…As a result, there is concern that surgical measures such as fundoplication may exacerbate esophageal disease, particularly dysphagia, in SSc. 152 Uncontrolled gastroesophageal reflux is a major risk factor for poor posttransplant outcomes, and therefore a thorough assessment of esophageal involvement in SSc-ILD is necessary pretransplant and an individualized approach to its management is the key. Some expert centers utilize center-specific strategies to manage these patients in the pre-and posttransplant period and surgical measures may be effective in selected patients.…”

Chronic opioid use and clinical outcomes in lung transplant recipients: A single‐center cohort study

“…9 Increased levels of healthcare utilization in patients prescribed chronic opioids are thought to be due to inadequate pain control secondary to hyperalgesia, 6 which may be caused by an upregulation of u-receptors. 25 In the LTx population, aspiration has long been known to have adverse clinical outcomes, [26][27][28][29] and Nissen fundoplication is frequently performed to reduce this risk. 30 Opioids are known to restrict the body's natural defenses against aspiration and lung infection or inflammation, via cough suppression and bronchoconstriction.…”