Gastroesophageal Reflux (GER) Is Highly Prevalent in Asymptomatic Patients Awaiting Lung Transplantation

Abstract

Gastroesophageal Reflux (GER) Is Highly Prevalent in Asymptomatic Patients Awaiting Lung Transplantation Kalyani Maganti, Connie Wigen, Lorinda Dollison, Juan C. Garcia Background: Bronchiolitis obliterans and its clinical correlate bronchiolitis obliterans syndrome are a major cause of morbidity and mortality following lung transplantation. Aspiration secondary to GER has been postulated to be a contributing factor. GER has also been shown to worsen following lung transplantation. Preoperative recognition would help anticipate management in these patients. Methods: A retrospective study was performed to determine the prevalence of GER in 14 consecutive end-stage lung disease patients being evaluated for lung transplantation. 12 had dual-channel esophageal 24-hour pH while 1 patient had BRAVO capsule testing. 13 patients underwent esophageal manometry. Results: Among the 14 patients, indications for lung transplant were as following: 6 emphysema, 3 idiopathic pulmonary fibrosis, 1 cystic fibrosis, 1 pulmonary hypertension, and 1 alpha 1 antitrypsin deficiency. 12 patients were asymptomatic for GER on presentation while 2 had heartburn. The lower esophageal sphincter was hypotensive in 9 (76%) patients with a mean lower esophageal sphincter pressure of 9.5 mm Hg. 4 (30%) had esophageal body dysmotility. Among those 2 had low amplitudes with ineffective esophageal motility, likely secondary to GER as evidenced by abnormal pH study, and 2 had nutcracker esophagus, one of whom had a positive DeMeester score. The overall DeMeester score was above normal in 9 (69%) patients with a mean score of 64.4 (normal !14.72). 7 (53%) were noted to have abnormal proximal acid exposure with a mean of 8.3% (normal !1.3% exposure). 9 (69%) had abnormal distal acid exposure with a mean of 18.4% (normal !4% exposure). Conclusions: GER is highly prevalent in end-stage lung disease patients and can be clinically silent. We conclude that all patients undergoing evaluation for lung transplantation, irrespective of symptoms, should be routinely investigated for GER in view of its possible contribution to allograft dysfunction.