title: Gastroesophageal reflux disease after lung transplantation: pathophysiology and implications for treatment.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) is thought to be a risk factor for the development or progression of chronic rejection after lung transplantation. However, the prevalence of GERD and its risk factors, including esophageal dysmotility, hiatal hernia and delayed gastric emptying after lung transplantation, are still unknown. In addition, the prevalence of Barrett's esophagus, a known complication of GERD, has not been determined in these patients. The purpose of this study was to determine the prevalence and extent of GERD, as well as the frequency of these risk factors and complications of GERD in lung transplant patients.
  
  
  METHODS
  Thirty-five consecutive patients underwent a combination of esophageal function testing, upper endoscopy, barium swallow, and gastric emptying scan after lung transplantation.
  
  
  RESULTS
  In this patient population, the prevalence of GERD was 51% and 22% in those who had been retransplanted. Of patients with GERD,36% had ineffective esophageal motility (IEM), compared with 6% of patients without GERD (P = .037). No patient demonstrated hiatal hernia on barium swallow. The prevalence of delayed gastric emptying was 36%. The prevalence of biopsy-confirmed Barrett's esophagus was 12%.
  
  
  CONCLUSIONS
  Our study shows that, after lung transplantation, more than half of patients had GERD, and that GERD was more common after retransplantation. IEM and delayed gastric emptying are frequent in patients with GERD. Hiatal hernia is rare. The prevalence of Barrett's esophagus is not negligible. We conclude that GERD is highly prevalent after lung transplantation, and that delayed gastric emptying and Barrett's esophagus should always be suspected after lung transplantation because they are common risks factors and complications of GERD.
authors: Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL 60153, USA.
authors: Christopher S
authors: CS
authors: Davis
authors: Vidya
authors: V
authors: Shankaran
authors: Elizabeth J
authors: EJ
authors: Kovacs
authors: James
authors: J
authors: Gagermeier
authors: Daniel
authors: D
authors: Dilling
authors: Charles G
authors: CG
authors: Alex
authors: Robert B
authors: RB
authors: Love
authors: James
authors: J
authors: Sinacore
authors: P Marco
authors: PM
authors: Fisichella
mesh_terms: D000328:Adult; D001471:Barrett Esophagus / Q000453:epidemiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult