Gastroesophageal Reflux and Esophageal Dysmotility in Patients Undergoing Evaluation for Lung Transplantation: Assessment, Evaluation, and Management

  • Robert B. Yates
  • Carlos A. Pellegrini
  • Brant K. Oelschlager


Gastroesophageal reflux disease (GERD) can dramatically affect quality of life but rarely results in significant complications. Moreover, since GERD can be effectively managed with proton pump inhibitor therapy, the disease is mostly thought of as a very benign condition—easy to diagnose and easy to treat. However, over the past 20 years, a darker side of GERD has emerged: GERD has become implicated in the development of several chronic progressive pulmonary diseases. Esophageal dysmotility is a common comorbid condition in patients with GERD, and this association is even stronger in patients with GERD and chronic lung disease. Importantly, when lung transplantation is considered as definitive therapy for end-stage lung disease, it is even more important to identify and treat GERD and esophageal dysmotility, because GERD is closely associated with the development of bronchiolitis obliterans syndrome, graft dysfunction, and even death. A thorough evaluation of any patient suspected to have GERD should include esophageal manometry and pH testing, an esophagram, and an upper gastrointestinal endoscopy. In any patient with confirmed GERD and life-limiting symptoms that are incompletely managed with medications, antireflux surgery should be considered. In patients with GERD and end-stage lung disease (before or after transplantation), antireflux surgery may mitigate the deleterious effects of GERD on lung function. Importantly, due to their multiple unique and complex medical needs, any patient with GERD and end-stage lung disease or a history of lung transplantation should be managed at a quaternary care center by a multidisciplinary team that includes an experienced gastroesophageal surgeon.


Gastroesophageal reflux disease Esophageal dysmotility Antireflux surgery Chronic lung disease Laryngopharyngeal reflux Extraesophageal reflux Lung transplantation 



Bronchiolitis obliterans


Connective tissue disease


Delayed gastric emptying


Forced expiratory volume in 1 s


Gastroesophageal junction


Gastroesophageal reflux


Gastroesophageal reflux disease


High-resolution esophageal manometry


Ineffective esophageal motility


Idiopathic pulmonary fibrosis


Lower esophageal sphincter


Proton pump inhibitor


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Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Robert B. Yates
    • 1
  • Carlos A. Pellegrini
    • 2
  • Brant K. Oelschlager
    • 3
  1. 1.Department of SurgeryNorthwest Hospital and Medical Center, University of Washington MedicineSeattleUSA
  2. 2.Department of SurgeryUniversity of WashingtonSeattleUSA
  3. 3.Division of General Surgery, Department of SurgeryUniversity of Washington Medical CenterSeattleUSA

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