Gastroesophageal reflux symptoms are not sufficient to guide esophageal function testing in lung transplant candidates

Posner, Shai; Zheng, Jiayin; Wood, Richard K.; Ra, Shimpi; Mg, Hartwig; Sc, Chow; Da, Leiman

doi:10.1093/dote/dox157

Cited by 30 publications

(24 citation statements)

References 29 publications

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“…Fifteen of 25 (60%) asymptomatic patients had an abnormal manometry or pH study. Given these findings, they supported esophageal studies (high-resolution manometry and pH study) in all patients being evaluated for lung transplant (13).…”

Section: Gastroesophageal Reflux and Lung Diseasesupporting

confidence: 67%

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: Gastroesophageal Reflux and Lung Diseasesupporting

confidence: 67%

Esophageal disease in lung transplant patients

Young¹,

Coppolino²

2021

Ann Transl Med

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“…In a study of end-stage lung disease patients presenting for esophageal function testing as part of prelung transplant evaluation, objective signs of reflux were found in 60% of patients with no reported esophageal symptoms of GERD. 15 Clinicians must, therefore, maintain a high degree of suspicion for GERD as a potential cause of pulmonary conditions, particularly in patients with no clear underlying cause or risk factors of lung diseases, suboptimal response to or progressive disease despite conventional therapy, and history of lung transplantation. Conversely, as GERD represents only one of many different predisposing factors for pulmonary dysfunction, and GERD may coexist with lung diseases without direct causal relationships, a careful, systematic approach to evaluating these patients is paramount for selecting candidates who may benefit from antireflux therapy.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Typical esophageal symptoms of GERD are often absent in patients with pulmonary complications of GERD. In a study of end‐stage lung disease patients presenting for esophageal function testing as part of prelung transplant evaluation, objective signs of reflux were found in 60% of patients with no reported esophageal symptoms of GERD 15 . Clinicians must, therefore, maintain a high degree of suspicion for GERD as a potential cause of pulmonary conditions, particularly in patients with no clear underlying cause or risk factors of lung diseases, suboptimal response to or progressive disease despite conventional therapy, and history of lung transplantation.…”

Section: Clinical Presentations and Evaluationmentioning

confidence: 99%

Extraesophageal syndrome of gastroesophageal reflux: relationships with lung disease and transplantation outcome

Chan

Ahuja

Fisichella

et al. 2020

Annals of the New York Academy of Sciences

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Gastroesophageal reflux disease (GERD) is prevalent and may be associated with both esophageal and extraesophageal syndromes, which include various pulmonary conditions. GERD may lead to pulmonary complications through the "reflux" (aspiration) or "reflex" (refluxate-triggered, vagally mediated airway spasm) mechanisms. While GERD may cause or worsen pulmonary disorders, changes in respiratory mechanics due to lung disease may also increase reflux. Typical esophageal symptoms are frequently absent and objective assessment with reflux monitoring is often needed for diagnosis. Impedance monitoring should be considered in addition to traditional pH study due to the involvement of both acidic and weakly acidic/nonacidic reflux. Antireflux therapy may improve outcomes of some pulmonary complications of GERD, although careful selection of a candidate is paramount to successful outcomes. Further research is needed to identify the optimal testing strategy and patient phenotypes that would benefit from antireflux therapy to improve pulmonary outcomes.

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“…Optou-se por utilizar a pHmetria de 24 horas para detecção de RGE em lugar da presença de sintomas típicos apresentados da doença do refluxo gastroesofágico, pois nem sempre esses pacientes comportam-se sintomaticamente como as pessoas sem doença respiratória. Esta estratégia é, rotineiramente, utilizada em pacientes com outras doenças respiratórias, como em candidatos a transplante pulmonar, condição onde o RGE está associado com disfunção de enxerto, justificando a prática rotineira da realização de manometria e pHmetria nesta população (52) . Embora seja uma tática efetiva na detecção RGE, ela não identifica o refluxo gastroesofágico não ácido, sendo este um viés desta investigação.…”

Section: Omeprazol Versus Observaçãounclassified

“…Diferentemente de outras doenças de via aérea e pulmonar como asma (30,31) , fibrose pulmonar (53) e bronquiolite obliterante (52,54) , há poucos estudos que correlacionam a estenose de traqueia benigna com RGE.…”

Section: Omeprazol Versus Observaçãounclassified

A influência do tratamento cirúrgico do refluxo gastroesofágico em pacientes com estenose de traqueia

Bianchi¹

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Gastroesophageal reflux symptoms are not sufficient to guide esophageal function testing in lung transplant candidates

Cited by 30 publications

References 29 publications

Esophageal disease in lung transplant patients

Esophageal disease in lung transplant patients

Extraesophageal syndrome of gastroesophageal reflux: relationships with lung disease and transplantation outcome

A influência do tratamento cirúrgico do refluxo gastroesofágico em pacientes com estenose de traqueia

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