Original article
General thoracic
Prevalence of Gastroesophageal Reflux in End-Stage Lung Disease Candidates for Lung Transplant

https://doi.org/10.1016/j.athoracsur.2005.03.106Get rights and content

Background

Aspiration secondary to gastroesophageal reflux has been postulated to be a contributing factor in bronchiolitis obliterans after lung transplantation. It is not clear whether gastroesophageal reflux is a preexisting condition or secondary to intraoperative vagal injury or drug-induced prolonged gastric emptying.

Methods

The prevalence of gastroesophageal reflux was examined in 78 consecutive end-stage lung disease patients assessed for lung transplantation: emphysema, 21; cystic fibrosis, 5; idiopathic pulmonary fibrosis, 26; scleroderma, 10; and miscellaneous diseases, 16. All underwent esophageal manometry. Two-channel esophageal 24-hour pH testing was completed in 76 patients. Gastric emptying studies were conducted in 36 patients.

Results

Typical gastroesophageal reflux symptoms were documented in 63% of patients. The lower esophageal sphincter was hypotensive in 72% of patients, and 33% had esophageal body dysmotility. Prolonged gastric emptying was documented in 44%, and 38% had abnormal pH testing. The overall DeMeester score was above normal in 32% of patients, and 20% had abnormal proximal pH probe readings.

Conclusions

Gastroesophageal reflux is highly prevalent in end-stage lung disease patients who are candidates for lung transplantation. Further investigation is needed to study the prevalence of gastroesophageal reflux after lung transplantation and its contribution to chronic allograft dysfunction.

Section snippets

Material and Methods

Starting January 2002, we evaluated 78 consecutive patients (38 women; median age, 55 years; range, 19 to 68 years) with advanced lung disease who were candidates for lung transplantation. The various lung diseases and the relative numbers of patients affected are listed in Table 1.Table 2 shows the demographics and the pulmonary function test results for each lung disease subgroup with 5 or more patients.

The same health professional (L.M.) interviewed all patients before esophageal function

Results

Gastroesophageal reflux–related symptoms were found in 63% (49 of 78) of all patients. Table 3 shows the symptom frequency according to the types of lung disease.

All patients tolerated the manometric assessment. The pH study was completed satisfactorily in 97% (76 of 78) of patients. The manometric findings in all patients and in patients grouped with respect to presence or absence of symptoms is shown in Table 4. Esophageal dysmotility, either characterized by abnormal peristalsis or abnormal

Comment

The association between lung disease and gastroesophageal reflux has been recognized for some time [21, 22, 23, 24, 25]. More recently gastroesophageal reflux has been documented to be highly prevalent in patients with a variety of lung diseases, in particular patients with asthma, cystic fibrosis, and idiopathic pulmonary fibrosis [13, 14, 15, 16, 17, 18]. Moreover gastroesophageal reflux has also been associated with the development of bronchiolitis obliterans–associated pneumonia [26]. A

References (42)

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