Lung transplantation exacerbates gastroesophageal reflux disease.
BACKGROUND
A high prevalence of gastroesophageal reflux (GER) has been reported in lung transplant recipients and is possibly linked to the development of bronchiolitis obliterans syndrome. The etiology of posttransplant GER remains unknown but may occur due to the transplant operation or posttransplant medications, or represent preexisting GER disease. We evaluated these possibilities by studying the nature and severity of GER in a cohort of patients before and after lung transplantation.


METHODS
Total, upright, and supine acid contact times were recorded in lung transplant recipients who underwent 24-h pH studies before and after transplantation. Patients also underwent esophageal manometry and gastric-emptying studies. Medications for acid suppression and gastric motility were discontinued before testing. Paired comparison between pretransplant and posttransplant results was performed using a paired t test.


RESULTS
Twenty-three patients were included in the analysis. The mean age was 51.5 years, and native diseases included emphysema (n = 11), cystic fibrosis (n = 4), pulmonary fibrosis (n = 3), and others (n = 5). Posttransplant studies occurred a median of 100 days after transplantation. After lung transplantation, the total acid contact time increased a mean of 3.7% (p = 0.03) and the supine acid contact time increased a mean of 6.4% (p = 0.019). Thirty-five percent (8 of 23 patients) had abnormal acid contact times before transplant, and 65% (15 of 23 patients) had abnormal acid contact after transplant. Changes in acid contact times were not explained by changes in esophageal or gastric motility. Only 20% (3 of 15 patients) with abnormal posttransplant pH studies were symptomatic.


CONCLUSIONS
There is a significant increase in GER after lung transplantation, as measured objectively by 24-h pH studies, despite a lack of symptoms in most patients. Further research is needed to determine the physiologic mechanisms of posttransplant GER and its impact on long-term allograft function.
Young
Lisa R
LR
Division of Medicine and Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
Hadjiliadis
Denis
D
Davis
R Duane
RD
Palmer
Scott M
SM
D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005745:Gastric Acidity Determination; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011187:Posture; D012189:Retrospective Studies