Chun Phoebe, Chan Megan, Nunley David, Balasubramanian Gokulakrishnan
Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Esophagus. 2025 Jun 11. doi: 10.1007/s10388-025-01135-6.
Gastroesophageal reflux is a well-studied risk factor for chronic lung allograft dysfunction in lung transplant recipients. Despite increasing evidence of esophageal dysmotility in lung transplant recipients, the relationship between esophageal contractility, esophageal barrier function, and reflux events has yet to be elucidated. We aimed to assess for changes in esophageal function before and after lung transplant using esophageal manometry, pH-impedance testing, and characterization of esophageal barrier function. We also performed correlational analyses aimed at further characterizing the observed changes in contractility and acid exposure time and identified potential driving factors for the observed relationships.
A retrospective review of medical records was performed for 36 patients who received a lung transplant (LTx) at an academic medical center in the United States between January 1, 2017 and July 23, 2019 who had undergone both pre and post-transplant high-resolution esophageal manometry and esophageal pH impedance studies. We further isolated 29 patients who did not receive narcotics within 30 days of their manometry and pH test. All manometry studies and esophageal pH impedance studies were read in a blinded manner after randomization. Reflux parameters, esophageal contractility metrics, and acute rejection scores were compared using non-parametric methods (Wilcoxon signed-rank test and the Exact McNemar's test).
We found no significant characteristic differences between our original cohort and our narcotics-excluded cohort. In our narcotics-excluded cohort, we found improvement in gastroesophageal reflux after lung transplant as evident by a decrease in distal AET. We found a significant increase in esophageal contractility post-lung transplantation when compared to pre-transplantation (p = 0.01). We also noted a significant decrease in the transdiaphragmatic pressure gradient (TPG) and mean upper esophageal sphincter (UES) pressure post-transplant. Driving factor analysis revealed that post-transplant distal contractile integral (DCI) was negatively correlated with distal acid exposure time (AET) (p = 0.041).
Our study demonstrated increased contractility after lung transplantation without a significant effect on GERD, possibly due to the observed inverse relationship between distal contractile integral and acid exposure time. Additionally, our study demonstrated a significant increase in esophagogastric junction barrier function and a significant decrease in upper esophageal barrier function which has not been shown in previous studies to our knowledge. Future studies are needed to evaluate the impact of these changes on allograft function.
胃食管反流是肺移植受者慢性肺移植功能障碍的一个经过充分研究的危险因素。尽管越来越多的证据表明肺移植受者存在食管动力障碍，但食管收缩性、食管屏障功能与反流事件之间的关系尚未阐明。我们旨在通过食管测压、pH阻抗测试和食管屏障功能特征评估肺移植前后食管功能的变化。我们还进行了相关性分析，以进一步描述观察到的收缩性和酸暴露时间的变化，并确定观察到的关系的潜在驱动因素。
对2017年1月1日至2019年7月23日在美国一家学术医疗中心接受肺移植（LTx）的36例患者的病历进行回顾性研究，这些患者在移植前后均接受了高分辨率食管测压和食管pH阻抗研究。我们进一步筛选出29例在测压和pH测试前30天内未使用麻醉剂的患者。所有测压研究和食管pH阻抗研究在随机分组后采用盲法进行解读。使用非参数方法（Wilcoxon符号秩检验和精确McNemar检验）比较反流参数、食管收缩性指标和急性排斥反应评分。
我们发现原始队列与排除麻醉剂的队列之间没有显著的特征差异。在排除麻醉剂的队列中，我们发现肺移植后胃食管反流有所改善，表现为远端酸暴露时间（AET）减少。与移植前相比，我们发现肺移植后食管收缩性显著增加（p = 0.01）。我们还注意到移植后跨膈压力梯度（TPG）和平均食管上括约肌（UES）压力显著降低。驱动因素分析显示，移植后远端收缩积分（DCI）与远端酸暴露时间（AET）呈负相关（p = 0.041）。
我们的研究表明，肺移植后收缩性增加，但对胃食管反流病没有显著影响，这可能是由于观察到远端收缩积分与酸暴露时间之间的负相关关系。此外，我们的研究表明食管胃交界屏障功能显著增加，食管上屏障功能显著降低，据我们所知，此前的研究尚未显示这一点。未来需要进行研究以评估这些变化对移植器官功能的影响。
