Is Screening for GERD Necessary in All Asymptomatic Lung Transplant Candidates?

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Background: Gastroesophageal reflux disease (GERD) is a known contributor to allograft dysfunction after lung transplantation. Evaluation for GERD has been advocated for all lung transplant candidates. The aim of this study is to evaluate the outcomes of GERD testing in lung transplant patients without GERD symptoms and determine if a subset can skip/defer these tests. Methods: A retrospective chart review was conducted on lung transplant candidates who had pre- transplant GI evaluation at our institution between 2019 and 2022. Adult patients were included if they reported no GERD symptoms and completed GERD screening with Multichannel intraluminal impedance-pH testing. Demographics and results of prior testing were collected for included patients. Results were analyzed using STATA. Results: 176 patients met inclusion criteria. 88 (50%) tested positive for GERD and 88 (50%) tested negative. 68/88 (77.3%) were positive by pH alone. Only 20/176 (11%) had elevated reflux episodes and were recommended to undergo anti-reflux procedures. There were no statistically significant differences in evaluated variables differentiating GERD+ versus GERD- patients. Conclusion: Lung transplant candidates without symptoms concerning for GERD tested positive for GERD 50% of the time with no reliable pre-test characteristics to stratify patients. The large majority of positive results were from high acid exposure time alone without elevated reflux episodes—a low risk phenotype for allograft dysfunction. Only 11% had increased reflux episodes and thus were recommended for anti-reflux procedures. Thus, deferring GERD screening in asymptomatic low-risk candidates until post-transplant is unlikely to impact clinical management while benefiting patients and health systems.