Transcutaneous Electrical Stimulation Rescues Gastric Emptying in Lung Transplant Patients with Moderate to Severe Gastroparesis
Gastroparesis (GP) is prevalent after lung transplant (Ltx) (50-68%). GP has been associated with symptoms and delayed absorption of medications. Of particular concern after Ltx, GP can predispose to gastroesophageal reflux disease considered the main culprit for chronic allograft dysfunction. Therefore, early diagnosis and treatment is recommended in Ltx patients. Pharmacologic intervention for GP is not efficacious to improve gastric emptying and can induce potential serious side effects. Transcutaneous electric stimulation (TES) has been proposed to improve motility in various gastrointestinal motility disorders
Gastroesophageal reflux disease (GERD) is a risk factor for chronic lung allograft dysfunction (CLAD). The presence of bile acids —putative markers of gastric microaspiration—and inflammatory proteins in the bronchoalveolar lavage (BAL) has been associated with CLAD, but their relationship with GERD remains unclear. While GERD is thought to drive chronic microaspiration, selection of patients for anti-reflux surgery lacks precision. This multicenter study aimed to test the association of BAL bile acids with GERD, lung inflammation, allograft function, and anti-reflux surgery.
This study examines the interaction of GERD and EsD on spirometry in LTRs.
The pulmonary microbiome modulates the immune milieu in the lung allograft and is in turn influenced by external factors such as microaspiration of oropharyngeal contents. A potential driver of microaspiration is gastroesophageal reflux disease (GERD), which has been associated with poor outcomes after lung transplantation. We aimed to compare the pulmonary microbiome in lung transplant recipients with and without GERD, and correlate microbial composition with concurrent lung inflammation.
Gastroesophageal reflux disease (GERD) is prevalent after lung transplantation (LTx) and has been associated with allograft injury and chronic lung allograft dysfunction (CLAD) presumably through chronic microaspiration of bile acids and other gastric contents with subsequent innate immune activation. Anti-reflux surgery is widely used at some centers to treat GERD in LTx; however, its role in inflammation or aspiration is unknown. Our objective was to examine the effects of early anti-GERD surgery in LTx recipients on markers of microaspiration and inflammation in the bronchoalveolar lavage (BAL).
Gastroesophageal reflux disease (GERD) is thought to expose the lungs to refluxed gastric contents leading to injury and chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTRs). Prior small studies showed correlations between lung bile acids and CLAD/survival. The goal of this study was to determine whether bile acid levels in the bronchoalveolar lavage (BAL) correlate with GERD, concurrent lung allograft inflammation, or development of CLAD.
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.
Gastro-oesophageal reflux disease (GORD) is thought to contribute to chronic allograft dysfunction following lung transplantation (LT) in adults, but paediatric data are limited. We hypothesise that Nissen ’s fundoplication (NF) reduces GORD, prevents a decrease in forced expiratory volume in one second (FEV1) and does not cause a short term post-operative fall in FEV1 in paediatric LT patients.
Microaspiration from gastroesophageal reflux disease (GERD) has been suggested to be a major contributor to the development of chronic lung allograft dysfunction (CLAD) and small cohort studies have linked non-acid reflux to the development of CLAD. We sought to further explore this relationship using esophageal high resolution manometry (HRM) and impedance/pH testing in a large single-center cohort.
In this study we describe the burden of reflux and gastroparesis in children undergoing lung transplant, and evaluates their impact on allograft survival and rejection incidence.