The Impact of Gastroesophageal Reflux and Esophageal Motility on Spirometry Following Lung Transplantation

L. N. Fessler, J. Mathew, K. Bazemore, E. Bush, S. Agbor-Enoh, P. D. Shah

Research output: Contribution to journalArticle

Abstract

PURPOSE: Although lung transplant recipients (LTR) with uncorrected gastroesophageal reflux disease (GERD) have been shown to have increased allograft complications, including lower early lung function and chronic lung allograft dysfunction development, the impact of esophageal dysmotility ( EsD) on lung function remains incompletely understood. This study examines the interaction of GERD and EsD on spirometry in LTRs. METHODS: 46 esophageal manometry, and pH impedance studies were available for review within 54 sequential lung transplant recipients at Johns Hopkins Hospital between July 2015 and June 2018. GERD was defined by either an abnormal DeMeester (>14) and/or abnormal impedance, and EsD was defined per any abnormal Chicago classification 3.0 diagnosis. Recipient, donor demographics and spirometry (FEV1) were captured up to post -op month nine, prior to any post-transplant fundoplication procedures. Categorical variables were compared using Kruskal Wallis test, and continuous variables with Rank Sum or Kruskal Wallis tests. RESULTS: Demographics and findings are displayed in table 1. There were no significant differences in pre transplant recipient and donor characteristics. Both LTR's with EsD and LTR's with any GERD had significantly lower median FEV1 values when compared to LTR without EsD or without GERD, respectively, at 6 months post-transplant. (1.82 vs 2.32, p<0.007, and 1.57 vs 2.13 <0.04). These differences persisted at month 9. LTR's with combined GERD and EsD had significantly lower median FEV1 compared to LTR's without either at both 6 months (1.52 vs 2.2 p< .03 ) and at 9 months 1.59 vs 2.18, p <0.02 ) and a trend towards worse FEV1 than with GERD or EsD alone. CONCLUSION: Our findings suggest that LTR's with combined EsD and GERD may be at highest risk of post- transplant allograft dysfunction. Further multivariate analysis of covariates, along with assessment of the impact of corrective procedures in LTR's with combined GERD/EsD may be helpful in guiding management.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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