Skip to main content
Log in

A review of the role of GERD-induced aspiration after lung transplantation

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

The increased prevalence of gastroesophageal reflux disease (GERD) in lung transplantation patients has been established; however, many questions persist regarding the relationship of GERD to aspiration and its potential to induce pulmonary allograft failure. Moreover, the biological implications of aspiration in lung transplantation have yet to be fully elucidated. The goal of this review was to assess the relationship between GERD and aspiration, focusing on the role of these events in the development of allograft injury after lung transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Trulock EP, Christie JD, Edwards LB, Boucek MM, Aurora P, Taylor DO, Dobbels F, Rahmel AO, Keck BM, Hertz MI (2007) Registry of the International Society for Heart, Lung Transplantation: twenty-fourth official adult lung, heart-lung transplantation report–2007. J Heart Lung Transpl 26(8):782–795

    Article  Google Scholar 

  2. Estenne M, Hertz MI (2002) Bronchiolitis obliterans after human lung transplantation. Am J Respir Crit Care Med 166:440–444

    Article  PubMed  Google Scholar 

  3. Hartwig MG, Appel JZ, Li B, Hsieh CC, Yoon YH, Lin SS, Irish W, Parker W, Davis RD (2006) Chronic aspiration of gastric fluid accelerates pulmonary allograft dysfunction in a rat model of lung transplantation. J Thorac Cardiovasc Surg 131(1):209–217

    Article  PubMed  Google Scholar 

  4. Lau CL, Palmer SM, Howell DN, McMahon R, Hadjiliadis D, Gaca J, Pappas TN, Davis RD, Eubanks S (2002) Laparoscopic antireflux surgery in the lung transplant population. Surg Endosc 16(12):1674–1678

    Article  PubMed  CAS  Google Scholar 

  5. Hadjiliadis D, Duane Davis R, Steele MP, Messier RH, Lau CL, Eubanks SS, Palmer SM (2003) Gastroesophageal reflux disease in lung transplant recipients. Clin Transpl 17(4):363–368

    Article  Google Scholar 

  6. Cantu E 3rd, Appel JZ 3rd, Hartwig MG, Woreta H, Green C, Messier R, Palmer SM, Davis RD Jr (2004) J. Maxwell Chamberlain memorial paper. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease. Ann Thorac Surg 78(4):1142–1151

    Article  PubMed  Google Scholar 

  7. Li B, Hartwig MG, Appel JZ, Bush EL, Balsara KR, Holzknecht ZE, Collins BH, Howell DN, Parker W, Lin SS, Davis RD (2008) Chronic aspiration of gastric fluid induces the development of obliterative bronchiolitis in rat lung transplants. Am J Transpl 8(8):1614–1621

    Article  CAS  Google Scholar 

  8. Sweet MP, Patti MG, Hoopes C, Hays SR, Golden JA (2009) Gastro-oesophageal reflux and aspiration in patients with advanced lung disease. Thorax 64(2):167–173

    Article  PubMed  CAS  Google Scholar 

  9. Bredenoord AJ, Tutuian R, Smout AJ, Castell DO (2007) Technology review: esophageal impedance monitoring. Am J Gastroenterol 102(1):187–194

    Article  PubMed  Google Scholar 

  10. Blondeau K, Mertens V, Vanaudenaerde BA, Verleden GM, Van Raemdonck DE, Sifrim D, Dupont LJ (2008) Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection. Eur Respir J 31(4):707–713

    Article  PubMed  CAS  Google Scholar 

  11. Riegelman RK (2000) Studying a study and testing a test: how to read the medical evidence, 4th edn. Lippincott Williams and Wilkins, Philadelphia

    Google Scholar 

  12. Ward C, Forrest IA, Brownlee IA, Johnson GE, Murphy DM, Pearson JP, Dark JH, Corris PA (2005) Pepsin-like activity in bronchoalveolar lavage fluid is suggestive of gastric aspiration in lung allografts. Thorax 60(10):872–874

    Article  PubMed  CAS  Google Scholar 

  13. Stovold R, Forrest IA, Corris PA, Murphy DM, Smith JA, Decalmer S, Johnson GE, Dark JH, Pearson JP, Ward C (2007) Pepsin, a biomarker of gastric aspiration in lung allografts: a putative association with rejection. Am J Respir Crit Care Med 175(12):1298–1303

    Article  PubMed  CAS  Google Scholar 

  14. D’Ovidio F, Mura M, Ridsdale R, Takahashi H, Waddell TK, Hutcheon M et al (2006) The effect of reflux and bile acid aspiration on the lung allograft and its surfactant and innate immunity molecules SP-A and SP-D. Am J Transpl 6(8):1930–1938

    Article  Google Scholar 

  15. Meers CM, De Wever W, Verbeken E, Mertens V, Wauters S, De Vleeschauwer SI, Vos R, Vanaudenaerde BM, Verleden GM, Van Raemdonck DE (2011) A porcine model of acute lung injury by instillation of gastric fluid. J Surg Res 166(2):e195–e204

    Article  PubMed  Google Scholar 

  16. D’Ovidio F, Mura M, Tsang M, Waddell TK, Hutcheon MA, Singer LG, Hadjiliadis D, Chaparro C, Gutierrez C, Pierre A, Darling G, Liu M, Keshavjee S (2005) Bile acid aspiration and the development of bronchiolitis obliterans after lung transplantation. J Thorac Cardiovasc Surg 129(5):1144–1152

    Article  PubMed  Google Scholar 

  17. Fisichella PM, Davis CS, Lundberg PW, Lowery E, Burnham EL, Alex CG, Ramirez L, Pelletiere K, Love RB, Kuo PC, Kovacs EJ (2011) The protective role of laparoscopic antireflux surgery against aspiration of pepsin after lung transplantation. Surgery 150(4):598–606

    Article  PubMed  Google Scholar 

  18. Neujahr DC, Mohammed A, Ulukpo O, Force SD, Ramirez AM, Pelaez A, Lawrence EC, Larsen CP, Kirk AD (2010) Surgical correction of gastroesophageal reflux in lung transplant patients is associated with decreased effector CD8 cells in lung lavages: a case series. Chest 138(4):937–943

    Article  PubMed  Google Scholar 

  19. Fisichella PM, Davis CS, Shankaran V, Gagermeier J, Dilling D, Alex CG, Kovacs EJ, Love RB, Gamelli RL (2011) Laparoscopic antireflux surgery for gastroesophageal reflux disease after lung transplantation. J Surg Res 170(2):e279–e286

    Article  PubMed  Google Scholar 

  20. Davis CS, Jellish WS, Fisichella PM (2010) Laparoscopic fundoplication with or without pyloroplasty in patients with gastroesophageal reflux disease after lung transplantation: how I do it. J Gastrointest Surg 14(9):1434–1441

    Article  PubMed  Google Scholar 

  21. Mertens V, Blondeau K, Vanaudenaerde B, Vos R, Farre R, Pauwels A, Verleden G, Van Raemdonck D, Dupont L, Sifrim D (2010) Gastric juice from patients “on” acid suppressive therapy can still provoke a significant inflammatory reaction by human bronchial epithelial cells. J Clin Gastroenterol 44(10):e230–e235

    PubMed  CAS  Google Scholar 

  22. Mertens V, Blondeau K, Van Oudenhove L, Vanaudenaerde B, Vos R, Farre R, Pauwels A, Verleden G, Van Raemdonck D, Sifrim D, Dupont LJ (2011) Bile acids aspiration reduces survival in lung transplant recipients with BOS despite azithromycin. Am J Transpl 11(2):329–335

    Article  CAS  Google Scholar 

Download references

Acknowledgment

This work was supported by funding from the 2011 SAGES Research Grant Award (PMF) for the study entitled “A noninvasive test to detect markers of aspiration after lung transplantation.”

Disclosure

Drs. Fisichella, Davis, and Kovacs have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to P. Marco Fisichella.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fisichella, P.M., Davis, C.S. & Kovacs, E.J. A review of the role of GERD-induced aspiration after lung transplantation. Surg Endosc 26, 1201–1204 (2012). https://doi.org/10.1007/s00464-011-2037-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-2037-y

Keywords

Navigation