Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Neurogastroenterol Motil. 2010 Aug;22(8):841-50. doi: 10.1111/j.1365-2982.2010.01522.x. Epub 2010 May 26.
Lung transplantation has become an effective therapeutic option for selected patients with end stage lung disease. Long-term survival is limited by chronic rejection manifest as bronchiolitis obliterans syndrome (BOS). The aspiration of gastric contents has been implicated as a causative or additive factor leading to BOS. Gastroesophageal reflux (GER) and altered foregut motility are common both before and after lung transplantation. Further, the normal defense mechanisms against reflux are impaired in the allograft. Recent studies using biomarkers of aspiration have added to previous association studies to provide a growing body of evidence supporting the link between rejection and GER. Further, the addition of high-resolution manometry (HRM) and impedance technology to characterize bolus transit and the presence and extent of reflux regardless of pH might better identify at-risk patients. Although additional prospective studies are needed, fundoplication appears useful in the prevention or treatment of post-transplant BOS.
This review will highlight the existing literature on the relationship of gastroesophageal reflux and altered motility to lung transplant rejection, particularly BOS. The article will conclude with a discussion of the evaluation and management of patients undergoing lung transplantation at our center.
肺移植已成为治疗终末期肺部疾病的有效选择。长期生存受到慢性排斥反应的限制，表现为闭塞性细支气管炎综合征（BOS）。胃内容物的吸入被认为是导致 BOS 的一个原因或附加因素。胃食管反流（GER）和移植前和移植后前肠运动改变很常见。此外，移植物的正常反流防御机制受损。最近使用吸入生物标志物的研究增加了之前的关联研究，为排斥反应和 GER 之间的联系提供了越来越多的证据。此外，高分辨率测压（HRM）和阻抗技术的应用可用于描述食团转运以及无论 pH 值如何存在和程度的反流，从而更好地识别高危患者。尽管需要进一步的前瞻性研究，但胃底折叠术似乎对预防或治疗移植后 BOS 有用。
本文将重点介绍有关胃食管反流和运动改变与肺移植排斥反应（尤其是 BOS）关系的现有文献。本文将讨论我们中心接受肺移植的患者的评估和管理。
