Lung Transplant Candidates With Pretransplant Gastroesophageal Reflux and Antibodies to Lung Self-antigens Have Shorter CLAD-free Survival After Transplant

Razia, Deepika; Mittal, Sumeet K.; Bansal, Sandhya; Ranjithkumar, R.; Smith, Michael A.; Walia, Rajat; Bremner, Ross M.; Mohanakumar, Thalachallour; Tokman, Sofya

doi:10.1097/txd.0000000000001294

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…Aspiration, the inhalation of oropharyngeal or gastric contents into the lower respiratory tract and larynx (1), is an important reason for morbidity and mortality from respiratory disease in children (2). Recurrent lung infections can be caused by aspiration, so early diagnosis and treatment are important to prevent lung damage (3).…”

Section: Introductionmentioning

confidence: 99%

Prolonged imaging time in the salivagram appears unnecessary for detecting aspiration

Wang¹,

Zhuang²,

Yang³

2023

Quant Imaging Med Surg

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Background: The salivagram was first described to detect possible lung aspiration in infants or young children. Its original protocol required dynamic imaging for 60 minutes, which has high sensitivity. The purpose of this retrospective investigation was to determine whether a shortened period of image acquisition can be adopted without significantly reducing the sensitivity of the test in detecting aspiration. Methods:The current salivagram protocol in our hospital requires 60 minutes of dynamic imaging. The images of a total of 398 patients (ages 1 month to 9 years old) with positive salivagrams were analyzed. The entire 60-minute dynamic images were divided into 6 periods, 10 minutes/period. The time of the onset of abnormal activity in the bronchi, which was evidence of aspiration in each patient, was recorded and assigned to the corresponding period.Results: Among all 398 patients with evidence of aspiration, tracheobronchial tree activity could be seen in the first 10 minutes of the dynamic imaging in 184 of them (46.2%, 184/398). The onset of the bronchial activity was seen between 10 and 20 minutes in 177 patients (44.5%, 177/398). A total of 35 patients (8.8%, 35/398) had the onset of abnormal tracheobronchial tree activity in the 3rd period between 20 and 30 minutes. During the 4 th period between 30 and 40 minutes, the onset of the aspiration occurred in only 2 patients (0.5%, 2/398). All patients had the onset of aspiration in the first 40 minutes of the dynamic imaging. Conclusions:The originally described 60-minute dynamic imaging protocol of the salivagram can be safely shortened to 40 or even 30 minutes without a significantly decreased chance of detecting aspiration.Prolonged imaging is unnecessary.

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Section: Introductionmentioning

confidence: 99%

Prolonged imaging time in the salivagram appears unnecessary for detecting aspiration

Wang¹,

Zhuang²,

Yang³

2023

Quant Imaging Med Surg

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“…GERD is also associated with cough, shortness of breath, deterioration of lung function, and increased frequency of respiratory exacerbations in patients with chronic lung disease 4 . Post‐lung transplant, persistent GERD is often thought to be the cause of rejection of transplanted lung 6 . Regarding the mechanism of association between GERD and chronic lung disease, arguments exist on both sides; lung disease may cause GERD, or the latter may cause lung disease.…”

Section: Introductionmentioning

confidence: 99%

“… 4 Post-lung transplant, persistent GERD is often thought to be the cause of rejection of transplanted lung. 6 Regarding the mechanism of association between GERD and chronic lung disease, arguments exist on both sides; lung disease may cause GERD, or the latter may cause lung disease. With regards to GERD causing lung disease, two possibilities have been proposed, (1) acid reflux into the esophagus may induce bronchospasm through a vagovagal reflex pathway, 7 and (2) micro-aspiration of refluxed material into the lung may cause chronic lung disease such as ILD.…”

Section: Introductionmentioning

confidence: 99%

Selective dysfunction of the crural diaphragm in patients with chronic restrictive and obstructive lung disease

Joshua,

Pathak,

Zifan

et al. 2023

Neurogastroenterology Motil

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BackgroundGastroesophageal reflux (GER) is known to be associated with chronic lung diseases. The driving force of GER is the transdiaphragmatic pressure (Pdi) generated mainly by costal and crural diaphragm contraction. The latter also enhances the esophagogastric junction (EGJ) pressure to guard against GER.MethodsThe relationship between Pdi and EGJ pressure was determined using high resolution esophageal manometry in patients with interstitial lung disease (ILD, n = 26), obstructive lung disease (OLD, n‐ = 24), and healthy subjects (n = 20).Key ResultsThe patient groups did not differ with respect to age, gender, BMI, and pulmonary rehabilitation history. Patients with ILD had significantly higher Pdi but lower EGJ pressures as compared to controls and OLD patients (p < 0.001). In control subjects, the increase in EGJ pressure at all‐time points during inspiration was greater than Pdi. In contrast, the EGJ pressure during inspiration was less than Pdi in 14 patients with ILD and 7 patients with OLD. The drop in EGJ pressure was usually seen after the peak Pdi in ILD group (p < 0.0001) and before the peak Pdi in OLD group, (p = 0.08). Nine patients in the ILD group had sliding hiatus hernia, compared to none in control subjects (p = 0.003) and two patients in the OLD, (p = 0.04).Conclusions and InferencesA higher Pdi and low EGJ pressure, and dissociation between Pdi and EGJ pressure temporal relationship suggests selective dysfunction of the crural diaphragm in patients with chronic lung diseases and may explain the higher prevalence of GERD in ILD as seen in previous studies.

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Collagen-V and K-α-1 Tubulin Antibodies as Potential Markers of Unsuspected GERD-Related Lung Damage: Insights from a Cross-Sectional Analysis

Latorre-Rodríguez,

Mittal,

Ravichandran

et al. 2024

Lung

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Purpose Our group has proposed that aspiration of gastric contents leads to exposure of normally sequestered lung self-antigens (SAgs), specifically collagen-V (Col-V) and K-α-1-tubulin (Kα1T), which elicits an immune response characterized by increasing concentrations of self-antibodies (SAbs) anti-Col-V and anti-Kα1T. We sought to establish the point prevalence of abnormally elevated concentrations of SAbs among patients with pathological gastroesophageal reflux disease (GERD) and/or hiatal hernia undergoing antireflux surgery (ARS). Methods For this cross-sectional study, we retrieved a plasma aliquot from the Norton Thoracic Institute BioBank from blood samples that were taken preoperatively from patients who underwent ARS between November 2019 and August 2022. Enzyme-linked immunosorbent assays were employed to detect and quantify anti-Col-V and anti-Kα1T. Results Samples from 43 patients (females, n = 34 [79.1%]; mean age, 62 ± 12 years; and mean BMI, 30.5 ± 7 kg/m2) were analyzed. Before ARS, 28 (65.1%, CI95: 50.3–80.0%) patients had abnormally elevated concentrations of anti-Col-V and 19 (44.2%, CI95: 28.7–59.7%) had elevated concentrations of circulating anti-Kα1T. Overall, 13 patients (30.2%) had low (i.e., normal) concentrations of both SAbs, 13 (30.2%) were positive only for one, and 17 (39.5%) were positive for both SAbs. Conclusion A relative high point prevalence of abnormally elevated circulating SAbs (i.e., anti-Col-V and/or anti-Kα1T) before ARS was found. This result suggests clinically unsuspected pulmonary parenchymal injury secondary to GERD-related aspiration. Further studies are required to confirm this hypothesis and to identify alternative non-invasive early biomarkers of GERD-related lung damage.

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Lung Transplant Candidates With Pretransplant Gastroesophageal Reflux and Antibodies to Lung Self-antigens Have Shorter CLAD-free Survival After Transplant

Abstract: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Cited by 5 publications

References 22 publications

Prolonged imaging time in the salivagram appears unnecessary for detecting aspiration

Prolonged imaging time in the salivagram appears unnecessary for detecting aspiration

Selective dysfunction of the crural diaphragm in patients with chronic restrictive and obstructive lung disease

Collagen-V and K-α-1 Tubulin Antibodies as Potential Markers of Unsuspected GERD-Related Lung Damage: Insights from a Cross-Sectional Analysis

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