Abstract
Background
Aspiration of gastroesophageal refluxate has been implicated in the pathogenesis of
idiopathic pulmonary fibrosis (IPF) and the progression of bronchiolitis obliterans
syndrome after lung transplantation. The goals of the present study were to identify
lung transplant patients at the greatest risk of aspiration and to investigate the
causative factors.
Materials and methods
From September 2009 to November 2011, 252 bronchoalveolar lavage fluid (BALF) samples
were collected from 100 lung transplant patients. The BALF pepsin concentrations and
the results of transbronchial biopsy, esophageal function testing, barium swallow,
and gastric emptying scan were compared among those with the most common end-stage
lung diseases requiring lung transplantation: IPF, chronic obstructive pulmonary disease,
cystic fibrosis, and α1-antitrypsin deficiency.
Results
Patients with IPF had higher BALF pepsin concentrations and a greater frequency of
acute rejection than those with α1-antitrypsin deficiency, cystic fibrosis, or chronic obstructive pulmonary disease
(P = 0.037). Moreover, the BALF pepsin concentrations correlated negatively with a lower
esophageal sphincter pressure and distal esophageal amplitude; negatively with distal
esophageal amplitude and positively with total esophageal acid time, longest reflux
episode, and DeMeester score in those with chronic obstructive pulmonary disease;
and negatively with the upright acid clearance time in those with IPF.
Conclusions
Our results suggest that patients with IPF after lung transplantation are at increased
risk of aspiration and a greater frequency of acute rejection episodes, and that the
risk factors for aspiration might be different among those with the most common end-stage
lung diseases who have undergone lung transplantation. These results support the role
of evaluating the BALF for markers of aspiration in assessing lung transplant patients
as candidates for antireflux surgery.
Keywords
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Article info
Publication history
Published online: July 01, 2013
Accepted:
June 5,
2013
Received in revised form:
June 4,
2013
Received:
December 18,
2012
Footnotes
Presented at the 32nd Annual Meeting and Scientific Sessions of the International Society of Heart and Lung Transplantation, Prague, Czech Republic, April 2012.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
