Acid reflux surgery could help prevent rejection in lung transplant patients
(Loyola University Health System) A procedure to treat acid reflux could help prevent chronic rejection in lung transplant patients, according to a study published in the American College of Surgeons.
Gastro-esophageal reflux and bile acids (BAs) aspiration is associated to chronic lung allograft dysfunction (CLAD). We investigated for the first time the reactivity of small airways to a comprehensive panel of BAs as detected in post lung transplant bronchial washings.
Gastroesophageal reflux and bile acid aspiration are risk factors for chronic lung allograft dysfunction. Bile acids may compromise the broncho-alveolar innate immunity by deranging the lipid surface barrier and/or by directly modulating macrophage activity. Targeted bile acid metabolomics and bacterial, fungal and viral cultures were investigated in post lung transplant surveillance bronchial washings.
The relationship between gastroesophageal reflux disease (GERD) and post-transplantation bronchiolitis obliterans syndrome (BOS) represents a topic of keen interest to thoracic surgeons, highlighting the interplay between 2 areas of our surgical repertoire: benign esophageal disease and end-stage lung failure. Although a number of contributing factors have been identified in the development and progression of BOS,1,2 GERD may importantly be one cause that is modifiable.
Gastroesophageal reflux disease (GERD) is prevalent after lung transplantation. Fundoplication slows lung function decline in patients with GERD, but the optimal timing of fundoplication is unknown.
Discussion Cystic fibrosis (CF) is an autosomal recessive disorder caused by mutations in the cystic fibrosis transmembrane receptor (CFTR). It is found in the epithelium of the bronchi, intestine, pancreatic duct and biliary tree. It regulates chloride, bicarbonate and water secretion. The heterozygous state helps prevent against secretory diarrhea, but the homozygous state causes thickened secretions in the hollow tubes of the lungs and digestive tract. There are multiple mutations (> 2000) which have been currently classified into classes depending on their protein production and activity. CF patients generally are l...
ConclusionsPost-lung transplant exposure to persistent PPI therapy results in the greatest protection against rejection in lung transplant recipients, independent of other clinical predictors including BMI, suggesting that PPI may have antireflux or anti-inflammatory effects in enhancing allograft protection.
Abstract Idiopathic pulmonary fibrosis (IPF) is a diagnostically challenging disease. Clinicians are faced with the need to exclude alternative diagnoses, limited treatment and management guidelines, and few treatment options. Patients with IPF have significantly increased healthcare usage compared with similar patients without the disease. Medicare estimates for this disease are as high as $3 billion, not including cost of treatment. The disease, characterized by worsening dyspnea, declining lung function, nonspecific respiratory symptoms, and a varied clinical course randomly punctuated by episodes of acute exac...
This article provides an overview of the epidemiology, pathophysiology, and guideline-recommended approaches for the diagnosis and management of IPF. PMID: 28978212 [PubMed - in process]
The objective of the study was to describe histopathological findings in surveillance lung transbronchial biopsies that can be correlated with episodes of BA in the lung allograft.
Conclusions LT was an effective treatment for advanced ILD and/or PH associated to SSc in our study. Gastroesophageal reflux was not a limitation for LT in SSc in this study. Complications and survival did not differ from non-SSc patients undergoing LT.