Esophageal motor disorders are frequent during pre and post lung transplantation. Can they influence lung rejection?

Ríos, Constanza Ciriza de los; Rodríguez-Valcárcel, Fernando Canga; Gafas, Alicia de Pablo; Lucas, Isabel Castel de; Pablos, David Lora; Tortajada, G Castellano

doi:10.17235/reed.2018.5263/2017

Cited by 7 publications

(9 citation statements)

References 25 publications

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“…Esophageal motor disorders such as distal spasm, hypercontractile esophagus and esophagogastric junction outflow obstruction were also observed more frequently post-lung transplant in the rejection group. This study supports the role of esophageal motor disorders leading to impaired esophageal clearance in the development of lung transplant rejection (20).…”

Section: Esophageal Disease After Lung Transplantationsupporting

confidence: 85%

Esophageal disease in lung transplant patients

Young¹,

Coppolino²

2021

Ann Transl Med

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There is a very well-established and complex interplay between gastroesophageal reflux and lung disease. This is particularly true in end-stage lung disease and post-lung transplant patients. Numerous studies have shown that in patients who are undergoing pre-lung transplant evaluations for diseases such as idiopathic pulmonary fibrosis (IPF), emphysema, connective tissue disease, there is a high prevalence of gastroesophageal reflux and esophageal dysmotility. Post-lung transplant, many of the reflux issues persist or worsen, and there is some evidence to suggest that this leads to worsened long-term allograft function and bronchiolitis obliterans. Anti-reflux operations in patients with lung disease have been shown to be safe in both the pre and post-lung transplant setting and lead to improved reflux symptoms, as well as protecting against reflux induced allograft dysfunction in the post-lung transplant patients. Barrett's esophagus and esophageal malignancy are also not unheard of in these patients, and select patients may benefit from operative intervention. This review discusses the links between gastroesophageal reflux and lung transplant patients in both the pre and post-transplant setting. We also review the approach to the workup of esophageal disease in the pre-lung transplant setting as well as the surgical management of this unique group of patients.

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Section: Esophageal Disease After Lung Transplantationsupporting

confidence: 85%

Esophageal disease in lung transplant patients

Young¹,

Coppolino²

2021

Ann Transl Med

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“…Similarly, the study by Gor et al 28 showed that EGJ CI was 46.20 ± 7.60 in healthy controls vs 89.22 ± 33.26 for LT patients in our study. These results also go along with previous studies that supported increased EGJ competency after LT. 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

Esophageal Motility Abnormalities in Lung Transplant Recipients With Esophageal Acid Reflux Are Different From Matched Controls

Elsheikh,

Akanbi,

Selby

et al. 2023

J Neurogastroenterol Motil

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Background/Aims There is an increased incidence of gastroesophageal reflux disease (GERD) after lung transplantation (LT) that can be associated with graft dysfunction. It is unclear if the underlying esophageal motility changes in GERD are different following LT. This study aimed to use esophageal high-resolution manometry (HRM) to explore GERD mechanisms in LT recipients compared to matched controls. Methods This was a retrospective study including patients with pathologic acid reflux who underwent HRM and pH testing at our healthcare facility July 2012 to October 2019. The study included 12 LT recipients and 36 controls. Controls were matched in a 1:3 ratio for age, gender, and acid exposure time (AET). Results LT recipients had less hypotensive esophagogastric junction (EGJ) (mean EGJ-contractile integral 89.2 mmHg/cm in LT vs 33.9 mmHg/cm in controls, P < 0.001). AET correlated with distal contractile integral and total EGJ-contractile integral only in LT group ( r = –0.79, P = 0.002 and r = –0.57, P = 0.051, respectively). Conclusions Following LT, acid reflux is characterized by a less hypotensive EGJ compared to controls with similar AET. The strongest correlation with AET after LT was found to be esophageal peristaltic vigor. These results add to the understanding of reflux after LT and may help tailor an individualized treatment plan.

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“…1,2 Esophageal dysmotility and gastroesophageal reflux (GER) are common in patients with respiratory disease, thought to be linked to disease progression, and are also common following LTx. The most common esophageal motor disorders include minor disorders of peristalsis, such as ineffective esophageal motility (IEM) and esophago-gastric junction outflow obstruction (EGJOO), [3][4][5][6][7][8][9] along with Jackhammer esophagus seen in some patients, mainly post-LTx, 4,[6][7][8][10][11][12] IEM is associated with greater numbers of proximal reflux events both in respiratory disease 9 and following LTx, 8 while EGJOO is associated with significantly less GER, despite an apparent increased risk of developing CLAD post-LTx. 8 Although studies have suggested that distal contractile integral (DCI) 4,6,7 and aperistalsis prior to LTx can improve following LTx, 13,14 it remains unclear whether certain motility diagnoses prior to LTx either remain the same or change to another diagnosis following LTx, and if this differs with type of respiratory disease.…”

Section: Introductionmentioning

confidence: 99%

“…The most common esophageal motor disorders include minor disorders of peristalsis, such as ineffective esophageal motility (IEM) and esophago-gastric junction outflow obstruction (EGJOO), [3][4][5][6][7][8][9] along with Jackhammer esophagus seen in some patients, mainly post-LTx, 4,[6][7][8][10][11][12] IEM is associated with greater numbers of proximal reflux events both in respiratory disease 9 and following LTx, 8 while EGJOO is associated with significantly less GER, despite an apparent increased risk of developing CLAD post-LTx. 8 Although studies have suggested that distal contractile integral (DCI) 4,6,7 and aperistalsis prior to LTx can improve following LTx, 13,14 it remains unclear whether certain motility diagnoses prior to LTx either remain the same or change to another diagnosis following LTx, and if this differs with type of respiratory disease. Given the differential effects that dysmotility can have on esophageal exposure to reflux, better understanding of the changes in motility diagnosis following LTx may help to explain the current lack of clarity on the effect of LTx on GER, as attested by some studies reporting a worsening 15 but others no effect.…”

Section: Introductionmentioning

confidence: 99%

“…Given the differential effects that dysmotility can have on esophageal exposure to reflux, better understanding of the changes in motility diagnosis following LTx may help to explain the current lack of clarity on the effect of LTx on GER, as attested by some studies reporting a worsening 15 but others no effect. 4,6,7,10 Moreover, better understanding of changes in motor diagnosis following LTx may have important implications for identifying those at an increased risk of post-LTx complications and guide specific interventions to mitigate these complications.…”

Section: Introductionmentioning

confidence: 99%

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The impact of lung transplantation on esophageal motility and inter‐relationships with reflux and lung mechanics in patients with restrictive and obstructive respiratory disease

Alghubari,

Cheah,

Z. Shah

et al. 2024

Neurogastroenterology Motil

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BackgroundFor many patients with lung disease the only proven intervention to improve survival and quality of life is lung transplantation (LTx). Esophageal dysmotility and gastroesophageal reflux (GER) are common in patients with respiratory disease, and often associate with worse prognosis following LTx. Which, if any patients, should be excluded from LTx based on esophageal concerns remains unclear. Our aim was to understand the effect of LTx on esophageal motility diagnosis and examine how this and the other physiological and mechanical factors relate to GER and clearance of boluses swallowed.MethodsWe prospectively recruited 62 patients with restrictive (RLD) and obstructive (OLD) lung disease (aged 33–75 years; 42 men) who underwent high resolution impedance manometry and 24‐h pH‐impedance before and after LTx.Key ResultsRLD patients with normal motility were more likely to remain normal (p = 0.02), or if having abnormal motility to change to normal (p = 0.07) post‐LTx than OLD patients. Esophageal length (EL) was greater in OLD than RLD patients' pre‐LTx (p < 0.001), reducing only in OLD patients' post‐LTx (p = 0.02). Reduced EL post‐LTx associated with greater contractile reserve (r = 0.735; p = 0.01) and increased likelihood of motility normalization (p = 0.10). Clearance of reflux improved (p = 0.01) and associated with increased mean nocturnal baseline impedance (p < 0.001) in RLD but not OLD. Peristaltic breaks and thoraco‐abdominal pressure gradient impact both esophageal clearance of reflux and boluses swallowed (p < 0.05).Conclusions and InferencesRLD patients are more likely to show improvement in esophageal motility than OLD patients post‐LTx. However, the effect on GER is more difficult to predict and requires other GI, anatomical and pulmonary factors to be taken into consideration.

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Esophageal motor disorders are frequent during pre and post lung transplantation. Can they influence lung rejection?

Abstract: Background: lung transplantation (LTx) is a viable option for most patients with end-

Cited by 7 publications

References 25 publications

Esophageal disease in lung transplant patients

Esophageal disease in lung transplant patients

Esophageal Motility Abnormalities in Lung Transplant Recipients With Esophageal Acid Reflux Are Different From Matched Controls

The impact of lung transplantation on esophageal motility and inter‐relationships with reflux and lung mechanics in patients with restrictive and obstructive respiratory disease

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