Gastroesophageal reflux and altered motility in lung transplant rejection.
BACKGROUND
Lung transplantation has become an effective therapeutic option for selected patients with end stage lung disease. Long-term survival is limited by chronic rejection manifest as bronchiolitis obliterans syndrome (BOS). The aspiration of gastric contents has been implicated as a causative or additive factor leading to BOS. Gastroesophageal reflux (GER) and altered foregut motility are common both before and after lung transplantation. Further, the normal defense mechanisms against reflux are impaired in the allograft. Recent studies using biomarkers of aspiration have added to previous association studies to provide a growing body of evidence supporting the link between rejection and GER. Further, the addition of high-resolution manometry (HRM) and impedance technology to characterize bolus transit and the presence and extent of reflux regardless of pH might better identify at-risk patients. Although additional prospective studies are needed, fundoplication appears useful in the prevention or treatment of post-transplant BOS.


OBJECTIVE
This review will highlight the existing literature on the relationship of gastroesophageal reflux and altered motility to lung transplant rejection, particularly BOS. The article will conclude with a discussion of the evaluation and management of patients undergoing lung transplantation at our center.
Castor
J M
JM
Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA. casto009@mc.duke.edu
Wood
R K
RK
Muir
A J
AJ
Palmer
S M
SM
Shimpi
R A
RA
D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D001989:Bronchiolitis Obliterans / Q000209:etiology* / Q000503:physiopathology; D015154:Esophageal Motility Disorders / Q000150:complications* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D018662:Fundoplication / Q000009:adverse effects; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006084:Graft Rejection / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects*; D008365:Manometry; D053120:Respiratory Aspiration / Q000150:complications
D015415:Biomarkers