Abnormalities of Esophageal Motor Activity Are Highly Prevalent in Lung Transplanted Patients

Purpose Background and aims. It was previously described that patients undergoing lung transplantation present an increased prevalence of gastroesophageal reflux disease (D'Ovidio et al, 2006). On the contrary, few studies provide information on esophageal motility. Available data described the presence of hypokinetic alterations, such as ineffective esophageal motility or nonspecific alterations (Au et al, 1993; D'Ovidio et al, 2005; Basseri et al, 2010). The aim of this study was, therefore, an in-depth characterization of esophageal motility in lung transplanted patients. Methods and Materials Thirty consecutive lung transplanted patients (M/F=19/11, mean age 44±13 yrs, range 24-66) underwent stationary esophageal manometry (Polygram, MedTronic). Median time since transplantation was 82 months (range 13-156). Lower esophageal sphincter (LES) motor activity and body peristalsis were evaluated. Results Hypotonic LES (<10 mmHg) was evident in 10% of subjects. Peristalsis was normal in 7 (23.3%) patients; aspecific abnormalities were present in 7 (23.3%) patients, nutcracker esophagus was present in 7 (23.3%) patients; ineffective esophageal motility was present in 3 (10%) patients; diffuse esophageal spasm was present in 6 (20%) patients. Both LES and peristaltic alterations were not correlated with time since transplantation, monolateral or bilateral transplantation, GERD coexistence or FEV1 impairment. One patient with nutcracker esophagus and one with SED presented chest pain, two patients with aspecific motor disorder, three with nutcracker esophagus and two with SED suffered from dysphagia. Conclusions The prevalence of esophageal motility alterations is very high in lung transplanted patients. As expected, the alterations involve both LES tone and esophageal peristalsis. In our series, a high prevalence of hyperkinetic motor disorders was evident and, in particular, of SED, a condition caused by nitrergic pathway impairment. Further studies are needed to ascertain the causative factor for this abnormality