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Symptomatic gastroesophageal reflux disease after lung transplantation

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Abstract

Purpose

Gastroesophageal reflux disease (GERD) is associated with allograft dysfunction after lung transplantation (LTX). We attempted to identify outcomes in LTX recipients with clinical evidence of GERD.

Methods

Retrospective review of 162 LTX recipients at our institution between January 1994 and June 2006 was performed. GERD was confirmed in symptomatic patients by esophagogastroduodenoscopy (EGD) and/or esophagography. Occurrence of biopsy-proven obliterative bronchiolitis (OB) and bronchiolitis obliterans syndrome (BOS) were analyzed. Kaplan-Meier analysis of survival and Cox proportional hazard analysis of risk factors were performed.

Results

GERD was diagnosed in 21 (13%) of patients, usually following LTX (71%). There was no difference in mean survival (1603 ± 300 vs. 1422 ± 131 days; log rank P > 0.05), or development of OB (5% vs. 6%, respectively; P > 0.05) in patients with GERD compared with patients without GERD. However, there was correlation between GERD and BOS (P = 0.01).

Conclusions

Symptomatic GERD is increased following LTX. Patients with symptomatic GERD demonstrated an increased incidence of BOS, but survival was not affected in this study. More sensitive and specific diagnostic tools should be implemented in all LTX recipients to investigate the impact of symptomatic and silent GERD and thus improve outcomes after LTX.

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References

  1. Trulock EP, Christie JD, Edwards LB, Boucek MM, Aurora P, Taylor DO, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult lung and heart-lung transplantation report—2007. J Heart Lung Transplant 2007;26:782–795.

    Article  PubMed  Google Scholar 

  2. Verleden GM, Dupont LJ, Van Raemdonck DE. Is it bronchiolitis obliterans syndrome or is it chronic rejection: a reappraisal? Eur Respir J 2005;25:221–224.

    Article  CAS  PubMed  Google Scholar 

  3. Reid KR, McKenzie FN, Menkis AH, Novick RJ, Pflugfelder PW, Kostuk WJ, et al. Importance of chronic aspiration in recipients of heart-lung transplants. Lancet 1990;336:206–208.

    Article  CAS  PubMed  Google Scholar 

  4. Au J, Hawkins T, Venables C, Morritt G, Scott CD, Gascoigne AD, et al. Upper gastrointestinal dysmotility in heart-lung transplant recipients. Ann Thorac Surg 1993;55:94–97.

    Article  CAS  PubMed  Google Scholar 

  5. Rinaldi M, Martinelli L, Volpato G, Pederzolli C, Silvestri M, Pederzolli N, et al. Gastro-esophageal reflux as cause of obliterative bronchiolitis: a case report. Transplant Proc 1995;27:2006–2007.

    CAS  PubMed  Google Scholar 

  6. Cantu E 3rd, Appel JZ 3rd, Hartwig MG, Woreta H, Green C, Messier R, et al. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease. Ann Thorac Surg 2004;78:1142–1151.

    Article  PubMed  Google Scholar 

  7. Davis RD Jr, Lau CL, Eubanks S, Messier RH, Hadjiliadis D, Steele MP, et al. Improved lung allograft function after fundoplication in patients with gastroesophageal reflux disease undergoing lung transplantation. J Thorac Cardiovasc Surg 2003;125:533–542.

    Article  PubMed  Google Scholar 

  8. D’Ovidio F, Mura M, Tsang M, Waddell TK, Hutcheon MA, Singer LG, et al. Bile acid aspiration and the development of bronchiolitis obliterans after lung transplantation. J Thorac Cardiovasc Surg 2005;129:1144–1152.

    Article  PubMed  Google Scholar 

  9. D’Ovidio F, Mura M, Ridsdale R, Takahashi H, Waddell TK, Hutcheon M, et al. The effect of reflux and bile acid aspiration on the lung allograft and its surfactant and innate immunity molecules SP-A and SP-D. Am J Transplant 2006;6:1930–1938.

    Article  PubMed  CAS  Google Scholar 

  10. Nicod LP. Mechanisms of airway obliteration after lung transplantation. Proc Am Thorac Soc 2006;3:444–449.

    Article  CAS  PubMed  Google Scholar 

  11. Weiss MJ, Madsen JC, Rosengard BR, Allan JS. Mechanisms of chronic rejection in cardiothoracic transplantation. Front Biosci 2008;13:2980–2988.

    Article  CAS  PubMed  Google Scholar 

  12. Hartwig MG, Appel JZ, Li B, Hsieh CC, Yoon YH, Lin SS, et al. Chronic aspiration of gastric fluid accelerates pulmonary allograft dysfunction in a rat model of lung transplantation. J Thorac Cardiovasc Surg 2006;131:209–217.

    Article  PubMed  Google Scholar 

  13. Young LR, Hadjiliadis D, Davis RD, Palmer SM. Lung transplantation exacerbates gastroesophageal reflux disease. Chest 2003;124:1689–1693.

    Article  PubMed  Google Scholar 

  14. Linden PA, Gilbert RJ, Yeap BY, Boyle K, Deykin A, Jaklitsch MT, et al. Laparoscopic fundoplication in patients with end-stage lung disease awaiting transplantation. J Thorac Cardiovasc Surg 2006;131:438–446.

    Article  PubMed  Google Scholar 

  15. Estenne M, Maurer JR, Boehler A, Egan JJ, Frost A, Hertz M, et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant 2002;21:297–310.

    Article  PubMed  Google Scholar 

  16. D’Ovidio F, Singer LG, Hadjiliadis D, Pierre A, Waddell TK, de Perrot M, et al. Prevalence of gastroesophageal reflux in end-stage lung disease candidates for lung transplant. Ann Thorac Surg 2005;80:1254–1260.

    Article  PubMed  Google Scholar 

  17. Hadjiliadis D, Duane Davis R, Steele MP, Messier RH, Lau CL, Eubanks SS, et al. Gastroesophageal reflux disease in lung transplant recipients. Clin Transplant 2003;17:363–368.

    Article  PubMed  Google Scholar 

  18. Sweet MP, Herbella FA, Leard L, Hoopes C, Golden J, Hays S, et al. The prevalence of distal and proximal gastroesophageal reflux in patients awaiting lung transplantation. Ann Surg 2006;244:491–497.

    PubMed  Google Scholar 

  19. Patti MG, Tedesco P, Golden J, Hays S, Hoopes C, Meneghetti A, et al. Idiopathic pulmonary fibrosis: how often is it really idiopathic? J Gastrointest Surg 2005;9:1053–1056.

    Article  PubMed  Google Scholar 

  20. Tobin RW, Pope CE 2nd, Pellegrini CA, Emond MJ, Sillery J, Raghu G. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 1998;158:1804–1808.

    CAS  PubMed  Google Scholar 

  21. Sweet MP, Patti MG, Leard LE, Golden JA, Hays SR, Hoopes C, et al. Gastroesophageal reflux in patients with idiopathic pulmonary fibrosis referred for lung transplantation. J Thorac Cardiovasc Surg 2007;133:1078–1084.

    Article  PubMed  Google Scholar 

  22. Button BM, Roberts S, Kotsimbos TC, Levvey BJ, Williams TJ, Bailey M, et al. Gastroesophageal reflux (symptomatic and silent): a potentially significant problem in patients with cystic fibrosis before and after lung transplantation. J Heart Lung Transplant 2005;24:1522–1529.

    Article  PubMed  Google Scholar 

  23. Ledson MJ, Tran J, Walshaw MJ. Prevalence and mechanisms of gastro-oesophageal reflux in adult cystic fibrosis patients. J R Soc Med 1998;91:7–9.

    CAS  PubMed  Google Scholar 

  24. Blondeau K, Mertens V, Vanaudenaerde BA, Verleden GM, Van Raemdonck DE, Sifrim D, et al. Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection. Eur Respir J 2008;31:707–713.

    Article  CAS  PubMed  Google Scholar 

  25. Moayyedi P, Talley NJ. Gastro-oesophageal reflux disease. Lancet 2006;367:2086–2100.

    Article  PubMed  Google Scholar 

  26. D’Ovidio F, Keshavjee S. Gastroesophageal reflux and lung transplantation. Dis Esophagus 2006;19:315–320.

    Article  PubMed  Google Scholar 

  27. Sato M, Keshavjee S. Bronchiolitis obliterans syndrome: alloimmune-dependent and -independent injury with aberrant tissue remodeling. Semin Thorac Cardiovasc Surg 2008;20:173–182.

    Article  PubMed  Google Scholar 

  28. Scott AI, Sharples LD, Stewart S. Bronchiolitis obliterans syndrome: risk factors and therapeutic strategies. Drugs 2005;65:761–771.

    Article  PubMed  Google Scholar 

  29. Knoop C, Estenne M. Acute and chronic rejection after lung transplantation. Semin Respir Crit Care Med 2006;27:521–533.

    Article  PubMed  Google Scholar 

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Author notes

  1. Mahender Macha

    Present address: , 11100 E. Michigan Avenue, Suite 301, Jackson, MI, 49201, USA

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA, USA

    Ezequiel J. Molina, Scott Short & Glen Monteiro

  2. Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, PA, USA

    John P. Gaughan

  3. Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA

    Mahender Macha

Authors
  1. Ezequiel J. Molina
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  2. Scott Short
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  3. Glen Monteiro
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  4. John P. Gaughan
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  5. Mahender Macha
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Corresponding author

Correspondence to Mahender Macha.

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Molina, E.J., Short, S., Monteiro, G. et al. Symptomatic gastroesophageal reflux disease after lung transplantation. Gen Thorac Cardiovasc Surg 57, 647–653 (2009). https://doi.org/10.1007/s11748-009-0486-1

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  • DOI: https://doi.org/10.1007/s11748-009-0486-1

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