Upper gastrointestinal dysmotility in heart-lung transplant recipients

Au, John; Hawkins, T; Venables, C W; Morritt, G. N.; Scott, Christopher D.; Gascoigne, A.; Corris, Paul A.; Hilton, Colin J.; Dark, John H.

doi:10.1016/0003-4975(93)90480-6

Cited by 79 publications

(48 citation statements)

References 12 publications

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“…Yet, no significant difference in total length and intra-abdominal length of LES was found between the two groups before and after operation. Thus, the alteration of the autonomous nervous system due to direct or indirect vagal injury during pneumonectomy may probably explain the results of LES resting pressure seen in Group A, since vagotomy in dogs and cats affects LES function variably and may lead to decreased resting tone or spasm [18]. Regarding relaxing pressure, after surgery we found a significant increase of its value in Group A compared with Group B in agreement with the data of Dougenis et al [15].…”

Section: Discussionsupporting

confidence: 90%

The effects of lung resection on physiological motor activity of the oesophagus†

Fiorelli

Vicidomini

Milione

et al. 2013

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES:To assess the modifications of oesophageal function after major lung resection and whether these modifications are correlated with the extent of resection ( pneumonectomy vs others). METHODS:In the last 5 years, 40 consecutive surgical patients with lung cancer were prospectively enrolled and divided in two groups: Group A (n = 20) patients scheduled for elective pneumonectomy and Group B (n = 20) for more limited resections (lobectomy or bilobectomy). In addition to routine evaluations, all patients underwent preoperative (within 5 days) and postoperative (6 months) oesophageal manometry to assess the lower oesophageal sphincter (LES), the oesophageal body and the upper oesophageal sphincter functions. Symptoms scoring questionnaires were recorded for each patient and the oesophageal dislocation assessed by radiological examinations.RESULTS: Thirty-three (15 of Group A and 18 of Group B) patients completed the study. After operation, we found that LES resting pressure was significantly lower in Group A compared with Group B (P = 0.01); conversely, the relaxing pressure resulted as being higher in Group A than in Group B (P = 0.01). In Group A compared with Group B, a significant reduction of amplitude and that of wave duration of oesophageal contractions were seen at the upper (0.0001 and 0.02, respectively), middle (0.0003 and 0.002, respectively) and lower (0.0001 and 0.0004, respectively) oesophageal body. In addition, 12 of 15 (80%) patients of Group A and 3 of 18 (17%) of Group B presented a lack of regular peristaltic movement (P = 0.001). Despite chest CT scan showing a shift of the oesophagus in 11 of 15 (73%) and 2 of 18 (11.1%) patients of Groups A and B (P = 0.001), the oesophagus dislocation resulted 'severe' on barium swallow study in only two patients of Group A. The manometric alterations were subclinical; heartburn was recorded in three patients (two of Group A and one of Group B) and epigastric pain in four (two for each group). No other symptoms were observed.CONCLUSIONS: Pneumonectomy may cause significant oesophageal motility disorders that are mostly subclinical. Thus, this type of surgery should not be denied to patients if required to treat their cancer.

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Section: Discussionsupporting

confidence: 90%

The effects of lung resection on physiological motor activity of the oesophagus†

Fiorelli

Vicidomini

Milione

et al. 2013

European Journal of Cardio-Thoracic Surgery

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“…[7][8][9][10] No clear etiology has been found in patients receiving solid organ transplants while chemotherapy effects have been postulated as a potential cause in stem cell transplant patients. [7][8][9][10] Signs and symptoms of gastroparesis occurred only in patients receiving allogeneic or matched unrelated donor transplants in our study. Based on our review of the literature, clinical gastroparesis is not a commonly recognized side-effect of either cyclosporine or tacrolimus.…”

Section: Discussionmentioning

confidence: 99%

Gastroparesis following bone marrow transplantation

Eagle

Gian

Lauwers

et al. 2001

Bone Marrow Transplant

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Summary:Patients often develop nausea, vomiting and bloating after bone marrow transplantation (BMT). These symptoms may interfere with nutrition and the ability to take oral medications. Gastroparesis is a recognized cause of these symptoms in non-transplant patients but less is known about patients who undergo BMT. Between January 1996 and March 1997, a total of 151 patients underwent BMT. Eighteen patients (12%) developed persistent symptoms suggestive of gastroparesis (persistent nausea, vomiting or bloating). Scintigraphic gastric emptying studies were performed to assess for gastroparesis. Prokinetic agents were administered at the time of study. The records on these patients were compared with those of all other patients undergoing BMT during the same time period without these symptoms. Nine patients who demonstrated delayed gastric emptying were further evaluated with esophagastroduodenoscopy and biopsy. Biopsy samples were reviewed for evidence of graft-versus-host disease (GVHD). Fourteen of 18 patients demonstrated delayed gastric emptying and most responded to prokinetic agents given at the time of study. Age, conditioning regimen, cytomegalovirus antigenemia and acute GVHD did not appear to be associated with the development of gastroparesis. Allogeneic BMT recipients were at higher risk than autologous BMT patients (26% vs 0%, P Ͻ 0.0001). Of allogeneic BMT recipients, there was a nonsignificant trend of patients receiving tacrolimus to be less likely to experience gastroparesis than those receiving cyclosporine (27% vs 48%, P = 0.08). For the nine patients undergoing upper endoscopy, GVHD on gastric biopsy was an uncommon finding and was mild when present. Gastroparesis appears to be a common cause of nausea, vomiting and bloating following allogeneic BMT. This may occur less often with tacrolimus than cyclosporine because of the former agent's prokinetic properties. Keywords: gastroparesis; hematopoietic cell transplant; gastric emptying; nausea and vomiting Following bone marrow transplantation (BMT), some patients develop persistent nausea, vomiting, bloating, early satiety and decreased tolerance to oral nutrition and medications. These symptoms frequently develop weeks after transplantation and inhibit weight gain, optimal nutrition and the transition from intravenous to oral medications.Gastroparesis is a disorder of motor function of the stomach in which gastric emptying is delayed. Patients with gastroparesis often develop symptoms of nausea, vomiting, bloating and distension. Gastroparesis has many known causes which include atrophic gastritis, diabetes, hypothyroidism, uremia, scleroderma, anticholinergics and stress. 1 Additionally, cytomegalovirus (CMV), herpes simplex virus (HSV) and other viral infections have been implicated as causes of delayed gastric emptying. 1,2 We performed gastric emptying studies on patients presenting with persistent nausea, vomiting and bloating following allogeneic or matched unrelated donor transplantation to assess for underlying gastroparesis and to as...

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“…[35][36][37][38][39] Subsequently, the lung transplantation team at Duke University initiated the first systematic and objective assessment of reflux in lung transplant patients. They measured distal oesophageal acid exposure in over 200 patients and found prevalences of 63% and 76% in the pre and posttransplant subgroups, respectively (table 1).…”

Section: Lung Transplantationmentioning

confidence: 99%