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Gastroesophageal reflux symptoms are not sufficient to guide esophageal function testing in lung transplant candidates.

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Date
2018-05
Authors
Posner, S
Zheng, J
Wood, RK
Shimpi, RA
Hartwig, MG
Chow, S-C
Leiman, DA
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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 article
Subject
Esophagus
Humans
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
Permalink
https://hdl.handle.net/10161/21592
Published Version (Please cite this version)
10.1093/dote/dox157
Publication 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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Scholars@Duke

Chow

Shein-Chung Chow

Professor of Biostatistics and 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
Hartwig

Matthew Hartwig

Associate Professor of Surgery
Leiman

David Asher Leiman

Assistant Professor of Medicine
Shimpi

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.
Wood

Richard Kevin Wood Jr.

Assistant 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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