Alghubari, A., Cheah, R., Shah, S.Z. et al. (4 more authors) (2024) The impact of lung transplantation on esophageal motility and inter‐relationships with reflux and lung mechanics in patients with restrictive and obstructive respiratory disease. Neurogastroenterology & Motility, 36 (6). e14788. ISSN 1350-1925
Abstract
Background: For many patients with lung disease the only proven intervention to improve survival and quality of life is lung transplantation (LTx). Esophageal dysmotility and gastroesophageal reflux (GER) are common in patients with respiratory disease, and often associate with worse prognosis following LTx. Which, if any patients, should be excluded from LTx based on esophageal concerns remains unclear. Our aim was to understand the effect of LTx on esophageal motility diagnosis and examine how this and the other physiological and mechanical factors relate to GER and clearance of boluses swallowed. Methods: We prospectively recruited 62 patients with restrictive (RLD) and obstructive (OLD) lung disease (aged 33–75 years; 42 men) who underwent high resolution impedance manometry and 24-h pH-impedance before and after LTx. Key Results: RLD patients with normal motility were more likely to remain normal (p = 0.02), or if having abnormal motility to change to normal (p = 0.07) post-LTx than OLD patients. Esophageal length (EL) was greater in OLD than RLD patients' pre-LTx (p < 0.001), reducing only in OLD patients' post-LTx (p = 0.02). Reduced EL post-LTx associated with greater contractile reserve (r = 0.735; p = 0.01) and increased likelihood of motility normalization (p = 0.10). Clearance of reflux improved (p = 0.01) and associated with increased mean nocturnal baseline impedance (p < 0.001) in RLD but not OLD. Peristaltic breaks and thoraco-abdominal pressure gradient impact both esophageal clearance of reflux and boluses swallowed (p < 0.05). Conclusions and Inferences: RLD patients are more likely to show improvement in esophageal motility than OLD patients post-LTx. However, the effect on GER is more difficult to predict and requires other GI, anatomical and pulmonary factors to be taken into consideration.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2024 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
Keywords: | 32 Biomedical and Clinical Sciences; 3201 Cardiovascular Medicine and Haematology; Clinical Research; Digestive Diseases; Rare Diseases; Lung; Humans; Male; Female; Middle Aged; Gastroesophageal Reflux; Aged; Adult; Lung Transplantation; Esophageal Motility Disorders; Manometry; Prospective Studies; Respiratory Mechanics; Lung Diseases, Obstructive; Esophagus; Esophageal pH Monitoring |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Medical Research (LIMR) > Division of Gastroenterology and Surgery |
Depositing User: | Symplectic Publications |
Date Deposited: | 07 Aug 2024 11:03 |
Last Modified: | 07 Aug 2024 11:03 |
Published Version: | http://dx.doi.org/10.1111/nmo.14788 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1111/nmo.14788 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:215833 |