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Foregut Dysmotility in the Lung Transplant Patient

  • Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract (S Rao and A Sharma, Section Editors)
  • Published:
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Abstract

Purpose of Review

To explore the role of upper gastrointestinal disease in the clinical course of lung transplant patients – including its pathophysiology, diagnostic testing, and treatment options.

Recent Findings

Gastroesophageal reflux disease (GERD) and foregut motility disorders are more prevalent among end-stage lung disease patients and are associated with poorer outcomes in lung transplant recipients. A proposed mechanism is the exposure of the lung allograft to aspirated contents, resulting in inflammation and rejection. Diagnostic tools to assess for these disorders include multichannel intraluminal impedance and pH (MII-pH) testing, high resolution esophageal manometry (HREM), and gastric emptying scintigraphy. The main treatment options are medical management with acid suppressants and/or prokinetic agents and anti-reflux surgery. In particular, data support the use of early anti-reflux surgery to improve outcomes.

Summary

Newer diagnostic tools such as MII-pH testing and HREM allow for the identification of both acid and non-acid reflux and esophageal motility disorders, respectively. Recent studies have demonstrated that early anti-reflux surgery within six months post-transplant better protects against allograft injury and pulmonary function decline when compared to late surgery. However, further prospective research is needed to evaluate the short and long-term outcomes of these diagnostic approaches and interventions.

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Authors and Affiliations

  1. Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Danny Wong

  2. Harvard Medical School, Boston, MA, USA

    Danny Wong & Walter W. Chan

  3. Division: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Walter W. Chan

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DW and WWC drafted the manuscript; DW and WWC contributed to critical revision of manuscript for important intellectual content; WWC provided administrative support and overall supervision. Additional writing assistance was not required.

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Correspondence to Walter W. Chan.

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This article is part of the Topical Collection on Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract

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Wong, D., Chan, W.W. Foregut Dysmotility in the Lung Transplant Patient. Curr Gastroenterol Rep 23, 23 (2021). https://doi.org/10.1007/s11894-021-00824-3

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