Skip to main content

Advertisement

SpringerLink
Log in

Consequences of Living-Donor Liver Transplantation for Upper Gastrointestinal Lesions: High Incidence of Reflux Esophagitis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

There is little information available regarding the consequences of living-donor liver transplantation (LDLT) for upper gastrointestinal lesions. We retrospectively compared the pre- and posttransplant incidences of noninfectious reflux esophagitis, portal hypertensive gastropathy (PHG), esophageal varix, gastroduodenal ulcer, Helicobacter pylori infection, and abnormal gastroesophageal valve in 29 adult patients (16 males, 13 females) who underwent LDLT for end-stage liver disease. Here we present four findings from this study. First, the posttransplant incidence of noninfectious esophagitis was significantly higher than the pretransplant incidence (27.6% vs. 3.4%; P < 0.001), irrespective of postoperative use of standard-dose H2RA. Second, PHG and esophageal varix, which were noted in 65.5% and 96.6% of pretransplant recipients, respectively, spontaneously resolved postoperatively in all cases. Third, H. pylori infection, which was observed in 50.0% of preoperative recipients, decreased to 5.6% postoperatively, although no significant difference was observed between the pre- and the posttransplant incidences of gastroduodenal ulcer (6.9% vs. 6.9%). Finally, the incidence of abnormal gastroesophageal valve did not change following LDLT (34.5% vs. 34.5%). In conclusion, this study suggests that noninfectious reflux esophagitis occurs more frequently following LDLT. Although the disease is the results of a very complex interaction of various factors, spontaneous resolution of PHG and serendipitous H. pylori eradication might have contributed to increased incidence of postoperative esophagitis, possibly through gastric acid hypersecretion. In contrast, morphological change of the gastroesophageal valve was not considered to be the cause of this disease. Because this study was a retrospective analysis of a small population of LDLT recipients, prospective randomized controlled studies of a sufficient number of cases are required to substantiate these conclusions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Everhart JE, Lombardero M, Detre KM, Zetterman RK, Wiesner RH, Lake JR, Hoofnagle JH (1997) Increased waiting time for liver transplantation results in higher mortality. Transplantation 64:1300–1306

    Article  PubMed  CAS  Google Scholar 

  2. Strong RW, Lynch SV, Ong TH, Matsunami H, Koido Y, Balderson GA (1990) Successful liver transplantation from a living donor to her son. N Engl J Med 322:1505–1507

    Article  PubMed  CAS  Google Scholar 

  3. Hashikura Y, Makuuchi M, Kawasaki S, Matsunami H, Ikegami T, Nakazawa Y, Kiyosawa K, Ichida T (1994) Successful living-related partial liver transplantation to an adult patient. Lancet 343:1233–1234

    Article  PubMed  CAS  Google Scholar 

  4. Shimazu M, Kitajima M (2004) Living donor liver transplantation with special reference to ABO-incompatible grafts and small-for-size grafts. World J Surg 28:2–7

    Article  PubMed  Google Scholar 

  5. Hashikura Y, Kawasaki S, Miyagawa S, Terada M, Ikegami T, Nakazawa Y, Urata K, Chisuwa H, Ogino S, Makuuchi M (2002) Recent advance in living donor liver transplantation. World J Surg 26:243–246

    Article  PubMed  Google Scholar 

  6. Cales P, Zabotto B, Meskens C, Caucanas JP, Vinel JP, Desmorat H, Fermanian J, Pascal JP (1990) Gastroesophageal endoscopic features in cirrhosis. observer variability, interassociations, and relationship to hepatic dysfunction. Gastroenterology 98:156–162

    CAS  Google Scholar 

  7. Sacchetti C, Capello M, Rebecchi P, Roncucci L, Zanghieri G, Tripodi A, Ponz de Leon M (1988) Frequency of upper gastrointestinal lesions in patients with liver cirrhosis. Dig Dis Sci 33:1218–1222

    Article  PubMed  CAS  Google Scholar 

  8. D'Amico G, Montalbano L, Traina M, Pisa R, Menozzi M, Spano C, Pagliaro L (1990) Natural history of congestive gastropathy in cirrhosis. The Liver Study Group of V. Cervello Hospital. Gastroenterology 99:1558–1564

    Google Scholar 

  9. Iwao T, Toyonaga A, Sumino M, Takagi K, Oho K, Nishizono M, Ohkubo K, Inoue R, Sasaki E, Tanikawa K (1992) Portal hypertensive gastropathy in patients with cirrhosis. Gastroenterology 102:2060–2065

    PubMed  CAS  Google Scholar 

  10. Rabinovitz M, Yoo YK, Schade RR, Dindzans VJ, Van Thiel DH, Gavaler JS (1990) Prevalence of endoscopic findings in 510 consecutive individuals with cirrhosis evaluated prospectively. Dig Dis Sci 35:705–710

    Article  PubMed  CAS  Google Scholar 

  11. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, Lundell L, Margulies M, Richter JE, Spechler SJ, Tytgat GN, Wallin L (1996) The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 111:85–92

    Article  PubMed  CAS  Google Scholar 

  12. McCormack TT, Sims J, Eyre-Brook I, Kennedy H, Goepel J, Johnson AG, Triger DR (1985) Gastric lesions in portal hypertension: Inflammatory gastritis or congestive gastropathy? Gut 26:1226–1232

    PubMed  CAS  Google Scholar 

  13. Ismail T, Bancewicz J, Barlow J (1995) Yield pressure, anatomy of the cardia and gastro-oesophageal reflux. Br J Surg 82:943–947

    PubMed  CAS  Google Scholar 

  14. Sontag SJ, Schnell TG, Miller TQ, Nemchausky B, Serlovsky R, O'Connell S, Chejfec G, Seidel UJ, Brand L (1991) The importance of hiatal hernia in reflux esophagitis compared with lower esophageal sphincter pressure or smoking. J Clin Gastroenterol 13:628–643

    Article  PubMed  CAS  Google Scholar 

  15. Kahrilas PJ, Lin S, Chen J, Manka M (1999) The effect of hiatus hernia on gastro-oesophageal junction pressure. Gut 44:476–482

    Article  PubMed  CAS  Google Scholar 

  16. Sloan S, Kahrilas PJ (1991) Impairment of esophageal emptying with hiatal hernia. Gastroenterology 100:596–605

    PubMed  CAS  Google Scholar 

  17. Stein HJ, Barlow AP, DeMeester TR, Hinder RA (1992) Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux. Ann Surg 216:35–43

    CAS  Google Scholar 

  18. Orlando RC, Bryson JC, Powell DW (1984) Mechanisms of H+ injury in rabbit esophageal epithelium. Am J Physiol 246:718–724

    Google Scholar 

  19. Collen MJ, Lewis JH, Benjamin SB (1990) Gastric acid hypersecretion in refractory gastroesophageal reflux disease. Gastroenterology 98:654–661

    PubMed  CAS  Google Scholar 

  20. Toyonaga A, Iwao T (1998) Portal-hypertensive gastropathy. J Gastroenterol Hepatol 13:865–877

    PubMed  CAS  Google Scholar 

  21. Kaur S, Kaur U, Agnihotri N, Tandon CD, Majumdar S (2001) Modulation of acid secretion in common bile duct ligation-related gastropathy in Wistar rats. J Gastroenterol Hepatol 16:755–762

    Article  PubMed  CAS  Google Scholar 

  22. Balan KK, Jones AT, Roberts NB, Pearson JP, Critchley M, Jenkins SA (1996) The effects of Helicobacter pylori colonization on gastric function and the incidence of portal hypertensive gastropathy in patients with cirrhosis of the liver. Am J Gastroenterol 91:1400–1406

    PubMed  CAS  Google Scholar 

  23. Yeh JL, Peng YC, Tung CF, Chen GH, Chow WK, Chang CS, Yeh HZ, Poon SK (2001) Role of Helicobacter pylori in cirrhotic patients with dyspepsia: a 13C-urea breath test study. Adv Ther 18:140–150

    PubMed  CAS  Google Scholar 

  24. Koike T, Ohara S, Sekine H, Iijima K, Abe Y, Kato K, Toyota T, Shimosegawa T (2001) Helicobacter pylori infection prevents erosive reflux oesophagitis by decreasing gastric acid secretion. Gut 49:330–334

    Article  PubMed  CAS  Google Scholar 

  25. Shirota T, Kusano M, Kawamura O, Horikoshi T, Mori M, Sekiguchi T (1999) Helicobacter pylori infection correlates with severity of reflux esophagitis: with manometry findings. J Gastroenterol 34:553–559

    Article  PubMed  CAS  Google Scholar 

  26. Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A (1986) Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology 91:897–904

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan

    Tomotaka Akatsu, Masashi Yoshida, Shigeyuki Kawachi, Minoru Tanabe, Motohide Shimazu & Masaki Kitajima

  2. Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan

    Koichiro Kumai

Authors
  1. Tomotaka Akatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masashi Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shigeyuki Kawachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Minoru Tanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Motohide Shimazu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koichiro Kumai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masaki Kitajima
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masashi Yoshida.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Akatsu, T., Yoshida, M., Kawachi, S. et al. Consequences of Living-Donor Liver Transplantation for Upper Gastrointestinal Lesions: High Incidence of Reflux Esophagitis. Dig Dis Sci 51, 2018–2022 (2006). https://doi.org/10.1007/s10620-006-9362-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-006-9362-3

Keywords

Search

Navigation