Clinical lung and heart/lung transplantationGastroesophageal Reflux (Symptomatic and Silent): A Potentially Significant Problem in Patients With Cystic Fibrosis Before and After Lung Transplantation
Section snippets
Methods
All patients with CF on the transplant waiting list and at least 2 months after bilateral sequential lung transplantation (LTx) for CF were invited to participate in a prospective study, which was approved by the Alfred Hospital ethics committee. All patients gave written informed consent for study participation. Patients with esophageal strictures or esophageal varices were excluded. Patients were investigated while off anti-reflux medication for at least 3 days (72 hours) during baseline
Results
A total of 24 patients were studied. In the group of patients on the lung transplant waiting list, the pre-LTx group, a total of 11 patients (6 males) completed the study. Thirteen patients (9 males) who underwent LTx for CF, and agreed to participate, formed the post-LTx group. One patient who initially agreed to be in the pre-LTx group was unable to tolerate the probe in situ for >30 minutes and had to be withdrawn from the study. No patients in the pre-LTx group were included in the post-LTx
Discussion
Before lung transplantation, factors such as chronic cough, hyperinflation, hyperalimentation, high-fat diet, overnight PEG feeds, delayed gastric emptying, postural drainage in head-down-tilted position and some medications may cause or exacerbate GER.4, 12, 14, 21 Alternatively, GER may cause cough and subsequent lung disease.14 Lung transplantation is widely accepted and practiced as a treatment modality for end-stage lung disease. The long-term outcomes remain limited, with 5-year survival
References (40)
- et al.
Complications of gastroesophageal reflux in patients with cystic fibrosis
J Pediatr
(1982) - et al.
Gastroesophageal reflux in patients with cystic fibrosis
J Pediatr
(1985) - et al.
Gastroesophageal reflux in the infant with cystic fibrosis
Am J Surg
(1985) - et al.
Association of lung perfusion disparity and mortality in patients with cystic fibrosis awaiting lung transplantation
J Heart Lung Transplant
(2002) Gastroesophageal reflux
- et al.
Assessment of survival benefit after lung transplantation by patient diagnosis
J Heart Lung Transplant
(2002) - et al.
Importance of chronic aspiration in recipients of heart-lung transplants
Lancet
(1990) - et al.
Improved lung allograft function following fundoplication in lung transplant patients with gastroesophageal disease undergoing lung transplantation
J Thorac Cardiovasc Surg
(2003) - et al.
Technique, indications, and clinical use of 24 hour esophageal pH monitoring
J Thorac Cardiovasc Surg
(1980) - et al.
Lung transplantation exacerbates gastroesophagael reflux disease
Chest
(2003)
Impaired gastrointestinal motility in pulmonary transplantation
Lancet
Gastroparesis after lung transplantationpotential role in postoperative respiratory complications
Chest
Gastric pacing for severe gastroparesis in a heart-lung transplant recipient
J Heart Lung Transplant
Surgical treatment of gastroesophageal reflux disease with an emphasis on respiratory symptoms
Reflux oesophagien dans la mucoviscidose
N Presse Med
New insights on gastro-oesophageal reflux in cystic fibrosis by longitudinal follow up
Arch Dis Child
The association of cystic fibrosis, gastroesophageal reflux, and reduced pulmonary function
Can Assoc Radiol J
Prevalence and mechanisms of gastro-oesophageal reflux in adult cystic fibrosis patients
J R Soc Med
Tracheal microaspiration in adult cystic fibrosis
J R Soc Med
Mechanisms of gastro-esophageal reflux in cystic fibrosis
Arch Dis Child
Cited by (112)
Update in Advancing the Gastrointestinal Frontier in Cystic Fibrosis
2022, Clinics in Chest MedicineSorting out the Relationship Between Esophageal and Pulmonary Disease
2021, Gastroenterology Clinics of North AmericaReview of Gastrointestinal Motility in Cystic Fibrosis
2021, Journal of Cystic FibrosisCitation Excerpt :Some data suggests that the use of prokinetic agents improves reflux symptoms, pointing toward delayed GE as a potential risk factor for GERD [50, 52, 53]. There are conflicting reports on the effect of GER on pulmonary function [47, 54-56]. For example, in a recent retrospective study using pH-multichannel intraluminal impedance study, GER had no impact on pulmonary function test results.
Gastroesophageal Reflux and Esophageal Motility Disorder After Lung Transplant: Influence on the Transplanted Graft
2021, Transplantation ProceedingsCitation Excerpt :There is not much information about whether the esophageal disorders in these patients are a consequence of the transplant or from previously existing disorders. On one hand, the association between GERD and pre-Tx lung diseases is well known [33-37]; on the other hand, there are also known post-LTx physiopathologic disorders that increase GERD, such as damage to the vagal nerve occurred during surgery or delay in the gastric emptying caused by immunosuppressive drugs. Although there is less information about EMD, peristalsis disorders and hypotension of the lower esophageal sphincter have also been described in patients before LTx associated with GERD [37], and some cases post-Tx have been published with hypercontractile disorders [13,38].
Cystic Fibrosis Foundation consensus guidelines for the care of individuals with advanced cystic fibrosis lung disease
2020, Journal of Cystic Fibrosis