title: Esophageal motor disease and reflux patterns in patients with advanced pulmonary disease undergoing lung transplant evaluation.
abstract: BACKGROUND
  Advanced pulmonary disorders are linked to esophageal hypomotility and reflux disease. However, characterization of esophageal function using high resolution manometry (HRM) and ambulatory pH monitoring, segregation by pulmonary pathology, and comparison to traditional reflux disease are all limited in the literature.
  
  
  METHODS
  Over a 4 year period, 73 patients (55.2 ± 1.3 years, 44F) were identified who underwent esophageal function testing as part of lung transplant evaluation for advanced pulmonary disease (interstitial lung disease, ILD = 47, obstructive lung disease, OLD = 24, other = 2). Proportions of patients with motor dysfunction (≥ 80% failed sequences = severe hypomotility) and/or abnormal reflux parameters (acid exposure time, AET ≥ 4%) were determined, and compared to a cohort of 1081 patients (48.4 ± 0.4 years, 613F) referred for esophageal function testing prior to antireflux surgery (ARS).
  
  
  RESULTS
  The proportion of esophageal body hypomotility was significantly higher within advanced pulmonary disease categories (35.6%), particularly ILD (44.7%), compared to ARS patients (12.1%, P < 0.0001). Abnormal AET was noted in 56.5%, and was similar between ILD and OLD, but less frequent than in the ARS group (P = 0.04). Post-transplant chronic rejection trended towards association with pretransplant elevated AET in OLD (P = 0.08) but not ILD. Mortality was not predicted by esophageal motor pattern or reflux evidence.
  
  
  CONCLUSIONS
  Interstitial lung disease has a highly significant association with esophageal body hypomotility. Consequently, prevalence of abnormal esophageal acid exposure is high, but implications for post lung transplant chronic rejection remain unclear.
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: J
authors.initials: J
authors.lastname: Seccombe
authors.forename: F
authors.initials: F
authors.lastname: Mirza
authors.forename: R
authors.initials: R
authors.lastname: Hachem
authors.forename: C P
authors.initials: CP
authors.lastname: Gyawali
mesh_terms: D015331:Cohort Studies; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D016040:Lung Transplantation; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies
keywords: GERD; advanced pulmonary disease; esophageal hypomotility