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Frank D'Ovidio
Andrew Pierre
Thomas K. Waddell
Marc de Perrot
Gail Darling
Shaf Keshavjee
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Ann Thorac Surg 2005;80:1254-1260
© 2005 The Society of Thoracic Surgeons

Original article: General thoracic

Prevalence of Gastroesophageal Reflux in End-Stage Lung Disease Candidates for Lung Transplant

Frank D'Ovidio, MD, PhD * , Lianne G. Singer, MD, Denis Hadjiliadis, MD, Andrew Pierre, MD, Thomas K. Waddell, PhD, Marc de Perrot, MD, Micheal Hutcheon, MD, Linda Miller, RN, Gail Darling, MD, Shaf Keshavjee, MD

Toronto Lung Transplant Program, University of Toronto, Toronto, Ontario, Canada

Accepted for publication March 28, 2005.

* Address reprint requests to Dr Keshavjee, Toronto Lung Transplant Program, Toronto General Hospital, 200 Elizabeth St EN10-224, Toronto ON, Canada, M5G 2C4 (Email: s.keshavjee{at}utoronto.ca).

BACKGROUND: Aspiration secondary to gastroesophageal reflux has been postulated to be a contributing factor in bronchiolitis obliterans after lung transplantation. It is not clear whether gastroesophageal reflux is a preexisting condition or secondary to intraoperative vagal injury or drug-induced prolonged gastric emptying.

METHODS: The prevalence of gastroesophageal reflux was examined in 78 consecutive end-stage lung disease patients assessed for lung transplantation: emphysema, 21; cystic fibrosis, 5; idiopathic pulmonary fibrosis, 26; scleroderma, 10; and miscellaneous diseases, 16. All underwent esophageal manometry. Two-channel esophageal 24-hour pH testing was completed in 76 patients. Gastric emptying studies were conducted in 36 patients.

RESULTS: Typical gastroesophageal reflux symptoms were documented in 63% of patients. The lower esophageal sphincter was hypotensive in 72% of patients, and 33% had esophageal body dysmotility. Prolonged gastric emptying was documented in 44%, and 38% had abnormal pH testing. The overall DeMeester score was above normal in 32% of patients, and 20% had abnormal proximal pH probe readings.

CONCLUSIONS: Gastroesophageal reflux is highly prevalent in end-stage lung disease patients who are candidates for lung transplantation. Further investigation is needed to study the prevalence of gastroesophageal reflux after lung transplantation and its contribution to chronic allograft dysfunction.




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