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Acid exposure time is sensitive for detecting gastroesophageal reflux disease and is associated with long-term survival after lung transplant.

Publication ,  Journal Article
Yang, NY; Parish, A; Posner, S; Shimpi, RA; Wood, RK; Finn, RT; Fisher, DA; Hartwig, MG; Klapper, JA; Reynolds, J; Niedzwiecki, D; Leiman, DA
Published in: Dis Esophagus
July 27, 2023

Gastroesophageal reflux disease (GERD) is common in patients who have undergone lung transplantation and is associated with poorer outcomes, but guidelines are lacking to direct management strategies in this population. We assessed the diagnostic yield of impedance metrics compared to pH-metry alone for detecting GERD among lung transplant recipients and evaluated their association with clinical outcomes. We performed a retrospective cohort study of consecutive patients who underwent lung transplantation. Demographic data, acid exposure time (AET), number of reflux episodes, mean nocturnal baseline impedance (MNBI), post-reflux swallowing-induced peristaltic wave index (PSPWI), and clinical outcomes including mortality were collected. The relationship between GERD metrics and clinical outcomes was assessed using Wilcoxon signed-rank test and Fisher's exact test as appropriate. Of the 76 patients studied, 29 (38%) had GERD based on abnormal AET after lung transplantation. One (1.3%) patient had GERD based on elevated number of reflux episodes and abnormal distal MNBI detected GERD in 19 (26%) patients, resulting in 62% sensitivity and 94% specificity. Two (2.6%) patients had normal PSPWI. Patients with low distal MNBI had significantly decreased forced expiratory volume in 1 second (FEV1) at 3-year posttransplant compared to those without low distal MNBI (P = 0.03). Three-year survival was significantly worse among patients with elevated AET (66.7% vs. 89.1%, P = 0.03) but not with low distal MNBI (68.4% vs. 84.3%, P = 0.18). Abnormal AET is more sensitive for detecting GERD than other reflux metrics studied and is associated with survival, suggesting pH-metry alone may be sufficient to guide GERD management after lung transplant.

Duke Scholars

Published In

Dis Esophagus

DOI

EISSN

1442-2050

Publication Date

July 27, 2023

Volume

36

Issue

8

Location

United States

Related Subject Headings

  • Survivors
  • Retrospective Studies
  • Lung Transplantation
  • Gastroesophageal Reflux
  • Gastroenterology & Hepatology
  • Esophagus
  • Esophageal pH Monitoring
  • Electric Impedance
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Yang, N. Y., Parish, A., Posner, S., Shimpi, R. A., Wood, R. K., Finn, R. T., … Leiman, D. A. (2023). Acid exposure time is sensitive for detecting gastroesophageal reflux disease and is associated with long-term survival after lung transplant. Dis Esophagus, 36(8). https://doi.org/10.1093/dote/doac114
Yang, Nancy Y., Alice Parish, Shai Posner, Rahul A. Shimpi, Richard K. Wood, R Thomas Finn, Deborah A. Fisher, et al. “Acid exposure time is sensitive for detecting gastroesophageal reflux disease and is associated with long-term survival after lung transplant.Dis Esophagus 36, no. 8 (July 27, 2023). https://doi.org/10.1093/dote/doac114.
Yang NY, Parish A, Posner S, Shimpi RA, Wood RK, Finn RT, et al. Acid exposure time is sensitive for detecting gastroesophageal reflux disease and is associated with long-term survival after lung transplant. Dis Esophagus. 2023 Jul 27;36(8).
Yang, Nancy Y., et al. “Acid exposure time is sensitive for detecting gastroesophageal reflux disease and is associated with long-term survival after lung transplant.Dis Esophagus, vol. 36, no. 8, July 2023. Pubmed, doi:10.1093/dote/doac114.
Yang NY, Parish A, Posner S, Shimpi RA, Wood RK, Finn RT, Fisher DA, Hartwig MG, Klapper JA, Reynolds J, Niedzwiecki D, Leiman DA. Acid exposure time is sensitive for detecting gastroesophageal reflux disease and is associated with long-term survival after lung transplant. Dis Esophagus. 2023 Jul 27;36(8).
Journal cover image

Published In

Dis Esophagus

DOI

EISSN

1442-2050

Publication Date

July 27, 2023

Volume

36

Issue

8

Location

United States

Related Subject Headings

  • Survivors
  • Retrospective Studies
  • Lung Transplantation
  • Gastroesophageal Reflux
  • Gastroenterology & Hepatology
  • Esophagus
  • Esophageal pH Monitoring
  • Electric Impedance
  • 3202 Clinical sciences
  • 1103 Clinical Sciences