Esophageal motor dysfunction and gastroesophageal reflux are prevalent in lung transplant candidates.
BACKGROUND
Gastroesophageal reflux and aspiration contribute to the development of bronchiolitis obliterans and accelerate graft deterioration after lung transplantation (LTx). We evaluated LTx candidates for esophageal motor abnormalities and gastroesophageal reflux.


METHODS
Consecutive patients evaluated for LTx underwent 24-hour pH monitoring using a dual-channel pH probe and high-resolution esophageal manometry. High-resolution manometry was also performed in healthy control subjects. The prevalence of abnormal acid exposure was noted in the LTx candidates.


RESULTS
Thirty LTx candidates and 10 control subjects were evaluated. Lung transplantation candidates had higher residual upper and lower esophageal sphincter pressures. The mean proportion of peristaltic swallows was 21% lower in LTx candidates. Both hypotensive and aperistaltic swallows were sixfold more prevalent in LTx candidates than in control subjects. All control subjects had normal high-resolution manometry whereas 23 LTx candidates (76.7%) had esophageal peristaltic dysfunction. Abnormal acid exposure time was seen in the proximal and distal esophagus in 25% and 36% of LTx candidates, respectively. Lung transplantation candidates with idiopathic pulmonary fibrosis had more aperistaltic contractions, more negative minimum intrathoracic pressure, and a higher frequency of abnormal distal esophagus acid exposure. The majority of patients with complications after LTx demonstrated motor, anatomic, or pH abnormalities.


CONCLUSIONS
Disordered esophageal motor function and gastroesophageal reflux are common in LTx candidates. We believe high-resolution esophageal manometry is a valid tool to use and the abnormalities we identified may be representative of this unique patient population. The role of this study in predicting a worse outcome should be further studied in patients after LTx.
Basseri
Benjamin
B
GI Motility Program, Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Conklin
Jeffrey L
JL
Pimentel
Mark
M
Tabrizi
Robert
R
Phillips
Edward H
EH
Simsir
Sinan A
SA
Chaux
George E
GE
Falk
Jeremy A
JA
Ghandehari
Sara
S
Soukiasian
Harmik J
HJ
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015154:Esophageal Motility Disorders / Q000453:epidemiology*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008365:Manometry; D008875:Middle Aged