Role of gastroesophageal reflux disease in lung transplantation

World Journal of Transplantation
Kelly E HathornWai-Kit Lo

Abstract

Lung transplantation is one of the highest risk solid organ transplant modalities. Recent studies have demonstrated a relationship between gastroesophageal reflux disease (GERD) and lung transplant outcomes, including acute and chronic rejection. The aim of this review is to discuss the pathophysiology, evaluation, and management of GERD in lung transplantation, as informed by the most recent publications in the field. The pathophysiology of reflux-induced lung injury includes the effects of aspiration and local immunomodulation in the development of pulmonary decline and histologic rejection, as reflective of allograft injury. Modalities of reflux and esophageal assessment, including ambulatory pH testing, impedance, and esophageal manometry, are discussed, as well as timing of these evaluations relative to transplantation. Finally, antireflux treatments are reviewed, including medical acid suppression and surgical fundoplication, as well as the safety, efficacy, and timing of such treatments relative to transplantation. Our review of the data supports an association between GERD and allograft injury, encouraging a strategy of early diagnosis and aggressive reflux management in lung transplant recipients to improve transplant ...Continue Reading

Citations

Feb 26, 2019·Expert Review of Respiratory Medicine·Ema Kavaliunaite, Paul Aurora
Dec 5, 2019·American Journal of Physiology. Lung Cellular and Molecular Physiology·Andreacarola UrsoJose F Perez-Zoghbi
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Aug 9, 2019·Journal of Clinical Gastroenterology·David J CangemiBraden Kuo
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