The Prevalence of Distal and Proximal Gastroesophageal Reflux in Patients Awaiting Lung Transplantation

Department of Medicine, University of California, San Francisco, San Francisco, California, United States
Annals of Surgery (Impact Factor: 8.33). 11/2006; 244(4):491-7. DOI: 10.1097/01.sla.0000237757.49687.03
Source: PubMed


To determine the prevalence and proximal extent of gastroesophageal reflux (GERD) in patients awaiting lung transplantation.
GERD has been postulated to contribute to accelerated graft failure in patients who have had lung transplantations. However, the prevalence of reflux symptoms, esophageal motility abnormalities, and proximal esophageal reflux among patients with end-stage lung disease awaiting lung transplantation are unknown.
A total of 109 patients with end-stage lung disease awaiting lung transplantation underwent symptomatic assessment, esophageal manometry, and esophageal pH monitoring (using a probe with 2 sensors located 5 and 20 cm above the lower esophageal sphincter).
Reflux symptoms were not predictive of the presence of reflux (sensitivity, 67%; specificity, 26%). Esophageal manometry showed a high prevalence of a hypotensive lower esophageal sphincter (55%) and impaired esophageal peristalsis (47%) among patients with reflux. Distal reflux was present in 68% of patients and proximal reflux was present in 37% of patients.
These data show that in patients with end-stage lung disease: 1) symptoms were insensitive and nonspecific for diagnosing reflux; 2) esophageal motility was frequently abnormal; 3) 68% of patients had GERD; 4) in 50% of the patients with GERD, acid refluxed into the proximal esophagus. We conclude that patients with end-stage lung disease should be screened with pH monitoring for GERD.

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Available from: Charles W Hoopes, Aug 14, 2014
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    • "In four patients with end-stage bronchiectasis, who completed dual-channel oesophageal pH monitoring, the prevalence of distal reflux of 75% and proximal reflux of 50% suggests that patients with more severe bronchiectasis may be more likely to have GOR [54]. However, the relationship of reflux to clinical presentation or its association with lung disease severity was not evaluated [54]. Similar results were found in a study of seven patients with advanced bronchiectasis awaiting lung transplantation, with 33% experiencing an increased number of distal reflux episodes, specifically in the supine position [55]. "
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