Hathorn Kelly E, Chan Walter W, Lo Wai-Kit
Kelly E Hathorn, Division of Internal Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States.
World J Transplant. 2017 Apr 24;7(2):103-116. doi: 10.5500/wjt.v7.i2.103.
Lung transplantation is one of the highest risk solid organ transplant modalities. Recent studies have demonstrated a relationship between gastroesophageal reflux disease (GERD) and lung transplant outcomes, including acute and chronic rejection. The aim of this review is to discuss the pathophysiology, evaluation, and management of GERD in lung transplantation, as informed by the most recent publications in the field. The pathophysiology of reflux-induced lung injury includes the effects of aspiration and local immunomodulation in the development of pulmonary decline and histologic rejection, as reflective of allograft injury. Modalities of reflux and esophageal assessment, including ambulatory pH testing, impedance, and esophageal manometry, are discussed, as well as timing of these evaluations relative to transplantation. Finally, antireflux treatments are reviewed, including medical acid suppression and surgical fundoplication, as well as the safety, efficacy, and timing of such treatments relative to transplantation. Our review of the data supports an association between GERD and allograft injury, encouraging a strategy of early diagnosis and aggressive reflux management in lung transplant recipients to improve transplant outcomes. Further studies are needed to explore additional objective measures of reflux and aspiration, better compare medical and surgical antireflux treatment options, extend follow-up times to capture longer-term clinical outcomes, and investigate newer interventions including minimally invasive surgery and advanced endoscopic techniques.
肺移植是风险最高的实体器官移植方式之一。最近的研究表明，胃食管反流病（GERD）与肺移植结局之间存在关联，包括急性和慢性排斥反应。本综述的目的是根据该领域的最新出版物，探讨肺移植中GERD的病理生理学、评估和管理。反流性肺损伤的病理生理学包括误吸和局部免疫调节在肺功能下降和组织学排斥反应发展中的作用，这反映了同种异体移植损伤。文中讨论了反流和食管评估的方式，包括动态pH监测、阻抗检测和食管测压，以及这些评估相对于移植的时机。最后，对抗反流治疗进行了综述，包括药物抑酸和手术胃底折叠术，以及这些治疗相对于移植的安全性、有效性和时机。我们对数据的综述支持GERD与同种异体移植损伤之间的关联，鼓励在肺移植受者中采取早期诊断和积极的反流管理策略，以改善移植结局。需要进一步研究来探索反流和误吸的其他客观测量方法，更好地比较药物和手术抗反流治疗方案，延长随访时间以获取长期临床结局，并研究包括微创手术和先进内镜技术在内的新干预措施。
