Lung transplant patients have high GERD prevalence
MedWire News: Patients who have undergone lung transplantation have a high prevalence of gastroesophageal reflux disease (GERD), particularly those who have been retransplanted, report US researchers.
Lung transplant patients have one of the lowest mean survival times of all solid organ transplantations, at only 5 years on average. This is largely due to the high rate of bronchiolitis obliterans syndrome (BOS), which develops in around half of these patients.
GERD is thought to increase the risk for development and progression of BOS. Piero Marco Fisichella (Loyola University Medical Center, Maywood, Illinois) and colleagues therefore investigated GERD prevalence in 35 consecutive lung transplant patients, aged 46-63 years.
The patients underwent a combination of esophageal function testing, upper endoscopy, barium swallow, and gastric emptying scanning following lung transplantation.
Overall, 51% of the cohort had GERD. When divided by type of transplant, 31%, 56%, and 100% of those who had unilateral, bilateral, and retransplant operations developed GERD.
The team found that 36% of the GERD patients had ineffective esophageal motility compared with only 6% of the non-GERD patients, a significant between-group difference.
In addition, 53% versus 18% of the GERD and non-GERD patients, respectively, had significantly delayed esophageal transit, with 60% versus 18% and 80% versus 29% of the corresponding groups having delays in liquid and solid gastric transit.
No GERD patients had hiatal hernia visualized by barium swallow, but 36% had delayed gastric emptying and 12% had biopsy confirmed Barrett's esophagus after endoscopy.
"We believe that the diagnosis of GERD in lung transplant patients should be an aggressive endeavor as GERD may contribute to BOS and rejection," write Fisichella et al.
"Therefore, in lung transplant patients with GERD, we support the role of laparoscopic antireflux surgery as a means to correct the risk factors for GERD and to prevent its complications, with the goal of preserving lung function," they conclude.
The results of this study are published in the journal Surgery.
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By Helen Albert