Gastroesophageal reflux symptoms are not sufficient to guide esophageal function testing in lung transplant candidates.
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2018-05
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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.
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Posner, S, J Zheng, RK Wood, RA Shimpi, MG Hartwig, S-C Chow and DA Leiman (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.
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Scholars@Duke
Richard Kevin Wood
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 cancer.
I also practice as a general gastroenterologist and see patients for routine screening colonoscopies.
Matthew Hartwig
Dr. Hartwig is a thoracic surgeon with a clinical focus in lung transplantation and robotic assisted minimally invasive thoracic surgery for the treatment of diseases of the chest. He serves as the Surgical Director of the Duke Lung Transplant Program and the Esophageal Center at Duke. Additionally, he directs the Surgical Office of Clinical Research, which manages the clinical research portfolio for the Department of Surgery. He also leads a successful program of clinical, basic and translational research in thoracic surgery and lung transplantation. He currently directs the Duke Ex Vivo Organ Laboratory (DEVOL), is the Chief of Lung Transplant Research, and is a faculty member at the Duke Clinical Research Institute (DCRI).
Dr. Hartwig has over 150 peer reviewed publications, received numerous awards, chaired many sessions at national and international meetings, serves regularly on NIH study sections, and is on the editorial board of many prominent journals. He has also personally mentored over pre-and post-doctoral trainees, many of whom are now engaged in their own successful research careers.
Shein-Chung Chow
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 am also interested in methodology development for statistical evaluation of traditional Chinese medicine (TCM) clinical trials.
David Asher Leiman
Dr. Leiman is an Associate Professor of Medicine and gastroenterologist specializing in esophageal diseases and swallowing disorders, such as eosinophilic esophagitis (EoE), motility disorders such as achalasia, and gastroesophageal reflux disease (GERD) as well as its associated complications including Barrett’s esophagus (BE). His busy clinical practice dovetails with his academic focus on health services research, including patient outcomes and clinical quality measurement. He is also a PI for several ongoing multicenter clinical trials investigating novel therapies for EoE and GERD.
Dr. Leiman has mentored numerous medical students, residents, and GI fellows on research and quality improvement projects resulting in research awards, presentations at national meetings, and peer-reviewed publications.
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