Division of Gastroenterology, Mayo Clinic Florida, Jacksonville, FL.
Division of Internal Medicine.
J Clin Gastroenterol. 2020 Apr;54(4):322-326. doi: 10.1097/MCG.0000000000001254.
We sought to determine the incidence of jackhammer esophagus (JE) after lung transplantation (LT) and identify potential risk factors for the development of JE after LT.
JE is a rare esophageal motility disorder, and its pathophysiology remains unclear. Lung transplantation has been implicated as a potential risk factor for JE, but the incidence of JE after LT is unknown.
A retrospective cohort of adult patients who underwent LT at 2 tertiary care centers over 7.5 years was reviewed. Analysis was performed on patients who underwent a high-resolution esophageal manometry (EM) study before and after LT. JE was defined according to the latest Chicago classification, version 3.0.
A total of 57 patients without JE identified on pre-LT EM also underwent an EM study after LT. Fifteen (25.4%) were found to have new JE after LT. Patients with newly diagnosed JE after LT were older (61.3±5.3 y vs. 51.6±15.6 y; P=0.02) and more often had chronic obstructive pulmonary disease (COPD; 47.6% vs. 16.6%; P=0.03) compared with those without COPD. There was a trend toward increased risk for JE among female individuals (60% vs. 33.3%; P=0.07) and those with shorter surgical anastomosis times (75.8±12.2 min vs. 84.4±14.3; P=0.06). There was no significant difference between body mass index, opioid use, pretransplant EM findings, surgical ischemic time, occurrence of gastroparesis, or measured post-LT outcomes between the 2 groups.
JE occurs not uncommonly in patients after LT. Older age and COPD pre-LT may be significant risk factors.
我们旨在确定肺移植（LT）后出现“震颠食管”（JE）的发生率，并确定 LT 后发生 JE 的潜在危险因素。
JE 是一种罕见的食管动力障碍，其病理生理学尚不清楚。肺移植已被认为是 JE 的潜在危险因素，但 LT 后 JE 的发生率尚不清楚。
回顾性分析了 2 家三级保健中心在 7.5 年期间接受 LT 的成年患者队列。对 LT 前和 LT 后进行高分辨率食管测压（EM）研究的患者进行了分析。JE 根据最新的芝加哥分类，版本 3.0 进行定义。
共有 57 名 LT 前 EM 未发现 JE 的患者也在 LT 后进行了 EM 研究。15 名（25.4%）患者在 LT 后被诊断为新 JE。与无 COPD 的患者相比，LT 后新诊断为 JE 的患者年龄更大（61.3±5.3 岁比 51.6±15.6 岁；P=0.02），更常患有慢性阻塞性肺疾病（COPD；47.6%比 16.6%；P=0.03）。在女性（60%比 33.3%；P=0.07）和手术吻合时间较短（75.8±12.2 分钟比 84.4±14.3 分钟；P=0.06）的个体中，JE 的风险呈上升趋势。两组之间的体重指数、阿片类药物使用、LT 前 EM 结果、手术缺血时间、胃轻瘫的发生或测量的 LT 后结果无显著差异。
JE 在 LT 后患者中并不罕见。LT 前年龄较大和 COPD 可能是重要的危险因素。
