Increased Incidence of Endoscopic Erosive Esophagitis in Solid Organ Transplant Recipients

Abstract

Background/AimsSolid organ transplant recipients frequently report gastrointestinal symptoms, especially heartburn or dyspepsia. However, the prevalence of endoscopic erosive esophagitis (EE) and associated risk factors after transplantation are unknown. The aim of this study was to determine whether there was a high incidence of endoscopic findings of EE in solid organ transplant recipients.MethodsThis retrospective case-control study included 256 of 3,152 solid organ transplant recipients who underwent sequential screening upper endoscopic examinations and an equal number of controls.ResultsForty-four (17.2%) and 16 (6.2%) cases of EE were detected in the solid organ transplant and control groups, respectively (p<0.001). In the multivariate analysis, transplantation was significantly associated with EE (odds ratio [OR], 6.48; 95% confidence interval, 2.74 to 15.35). Factors such as old age (OR, 1.17), the presence of a hiatal hernia (OR, 5.84), an increased duration of immunosuppression (OR, 1.07), and the maintenance administration of mycophenolate mofetil (OR, 4.13) were independently associated with the occurrence of EE in the solid organ transplant recipients.ConclusionsA significant increase in the incidence of endoscopically detected EE was observed in solid organ transplant recipients. This increased incidence was associated with the type and duration of the immunosuppressive therapy.

Factors leading to dyspepsia in renal transplant recipients

“…GERD develops when increased acidic gastric secretion refluxes into the esophagus [ 3 , 4 ]. Gastrointestinal (GI) symptoms are commonly experienced in solid organ transplant recipients and can effects any part of the GI tract [ 5 ]. After three years of renal transplant, about 23% of the patients have GERD, reflux esophagitis (RE) and dyspepsia in 20%, 5% and 6%, respectively [ 6 ].…”

“…Neri et al proposed that renal transplanted patients having GERD, dyspepsia or reflux esophagitis are at increased risk of graft failure and death [ 6 ]. Kim et al reported severe complications in around 10% resulting in graft loss and death [ 5 ]. The rationale of this study is to determine factors leading to dyspepsia in renal transplant recipients, as no local study have been done so far for evaluation of dyspepsia in these patients.…”

Mycophenolate induced GI mucosal injury – case report and review of the literature

“…4 These injuries tend to occur early, usually within the first three to twelve months of initiating MMF therapy. 6 The risk of gastroduodenal erosions was approximately 1.83 fold for MMF, with the highest risk of erosive lesions associated with MMF-tacrolimuscorticosteroid combination treatment. [6][7][8] While it is important to consider MMF as a possible cause of esophageal injury in a post-transplant patient, one must first consider other more common causes, including reflux esophagitis, pill esophagitis, infectious esophagitis (HSV, CMV, and candida), radiation esophagitis, and corrosive ingestion.…”

“…6 The risk of gastroduodenal erosions was approximately 1.83 fold for MMF, with the highest risk of erosive lesions associated with MMF-tacrolimuscorticosteroid combination treatment. [6][7][8] While it is important to consider MMF as a possible cause of esophageal injury in a post-transplant patient, one must first consider other more common causes, including reflux esophagitis, pill esophagitis, infectious esophagitis (HSV, CMV, and candida), radiation esophagitis, and corrosive ingestion. In the middle and lower GI tract, the differential diagnosis should also include inflammatory bowel disease, infections (bacterial, viral, and parasitic), microscopic colitis, malabsorption, post-transplant immunoproliferative disease, and ischemia.…”

“…5 Whereas middle and lower GI tract injuries may reflect the antimetabolite activity of MMF, resulting in GVHD-like changes such as colitis; the upper GI mucosal injuries may reflect local mucosal irritation, giving rise to erosive esophagitis (EE), reactive gastropathytype changes and/orduodenal ulcers. 4 Soo Kim et al 6 showed a significant correlation between incidence of erosive esophagitis and MMF therapy in solid transplant recipients. Furthermore, Parfitt et al 4 documented that out of 7 esophageal biopsies from patients on MMF, 5 displayed variable degrees of active esophagitis.…”