Gastroesophageal reflux symptoms are not sufficient to guide esophageal function testing in lung transplant candidates.
Abstract
Gastroesophageal reflux disease and esophageal dysmotility are prevalent in patients
with advanced lung disease and are associated with graft dysfunction following lung
transplantation. As a result, many transplant centers perform esophageal function
testing as part of the wait-listing process but guidelines for testing in this population
are lacking. The aim of this study is to describe whether symptoms of gastroesophageal
reflux correlate with abnormal results on pH-metry and high-resolution manometry and
can be used to identify those who require testing. We performed a retrospective cohort
study of 226 lung transplant candidates referred for high-resolution manometry and
pH-metry over a 12-month period in 2015. Demographic data, results of a standard symptom
questionnaire and details of esophageal function testing were obtained. Associations
between the presence of symptoms and test results were analyzed using Fisher's exact
tests and multivariable logistic regression. The most common lung disease diagnosis
was interstitial lung disease (N = 131, 58%). Abnormal pH-metry was seen in 116 (51%)
patients and the presence of symptoms was significantly associated with an abnormal
study (p < 0.01). Dysmotility was found in 98 (43%) patients, with major peristaltic
or esophageal outflow disorders in 45 (20%) patients. Symptoms were not correlated
with findings on esophageal high-resolution manometry. Fifteen of 25 (60%) asymptomatic
patients had an abnormal manometry or pH-metry. These results demonstrate that in
patients with advanced lung disease, symptoms of gastroesophageal reflux increase
the likelihood of elevated acid exposure on pH-metry but were not associated with
dysmotility. Given the proportion of asymptomatic patients with abnormal studies and
associated post-transplant risks, a practice of universal high-resolution manometry
and pH-metry testing in this population is justifiable.
Type
Journal articleSubject
EsophagusHumans
Esophageal Motility Disorders
Gastroesophageal Reflux
Lung Diseases
Postoperative Complications
Lung Transplantation
Retrospective Studies
Reproducibility of Results
Manometry
Adult
Middle Aged
Female
Male
Esophageal pH Monitoring
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https://hdl.handle.net/10161/21592Published Version (Please cite this version)
10.1093/dote/dox157Publication Info
Posner, S; Zheng, J; Wood, RK; Shimpi, RA; Hartwig, MG; Chow, S-C; & Leiman, DA (2018). Gastroesophageal reflux symptoms are not sufficient to guide esophageal function testing
in lung transplant candidates. Diseases of the esophagus : official journal of the International Society for Diseases
of the Esophagus, 31(5). 10.1093/dote/dox157. Retrieved from https://hdl.handle.net/10161/21592.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Shein-Chung Chow
Professor of Biostatistics & Bioinformatics
My research interest includes statistical methodology development and application
in the area of biopharmaceutical/clinical statistics such as bioavailability and bioequivalence,
clinical trials, bridging studies, medical devices, and translational research/medicine.
Most recently, I am interested in statistical methodology development for the use
of adaptive design methods in clinical trials and methodology development for assessment
of biosimilarity of follow-on biologics. In addition, I
Matthew Hartwig
Professor of Surgery
Dr. Hartwig is a thoracic surgeon with a clinical focus in robotic assisted minimally
invasive thoracic surgery for the treatment of diseases of the chest. He serves as
the Surgical Director of the Esophageal Center at Duke. He is also the Director of
the Minimally Invasive Thoracic Surgery Fellowship at Duke, while providing advanced
instruction in robotic surgery to surgeons around the world. He also leads a successful
program of clinical, basic and translational research in tho
David Asher Leiman
Associate Professor of Medicine
Rahul Arun Shimpi
Assistant Professor of Medicine
I have clinical and research interests and expertise in general gastroenterology and
esophageal disorders, including gastroesophageal reflux disease, Barrett’s esophagus,
and esophageal motility disorders.
Richard Kevin Wood Jr.
Associate Professor of Medicine
I am an academic esophagologist and medical educator.I am the program director for
the Gastroenterology and Hepatology Training Program at Duke.My clinical area of specialty
is in esophageal disorders. I see patients with a wide range of esophageal problems
including: gastroesophageal reflux diseaase (GERD); swallowing disorders; primary
esophageal motility disorders including achalasia, esophageal spasm, and jackhammer
esophagus; Barrett's esophagus; and Esophageal
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