P2395 - Range and Severity of Atypical and Typical Gastroesophageal Reflux Symptoms in Patients Undergoing Lung Transplant Evaluation

Roshni Bhat, BS¹, Rishabh Khatri, MD², Dariush Shahsavari, MD³, Zubair Malik, MD⁴, Henry P. Parkman, MD^4
1Lewis Katz School of Medicine at Temple University, Philadelphia, PA; ²Temple University Hospital, Philadelphia, PA; ³Temple University School of Medicine, Philadelphia, PA; ⁴Temple University, Philadelphia, PA

Introduction: Lung transplant candidates undergo high-resolution esophageal manometry (HREM) and multi-luminal impedance-pH (MII-pH) studies to screen for gastroesophageal reflux disorder (GERD). GERD prevalence, symptom severity, and demographic features in this population are not well defined.

Methods: We analyzed HREM and MII-pH reports of lung transplant candidates presenting to our tertiary center between 2017-2020 along with a 29-item questionnaire that patients received prior to studies. The questionnaire asked about esophageal symptoms including heartburn, regurgitation, trouble swallowing, chest pain, coughing, hoarseness, shortness of breath (SOB), wheezing, belching, nausea, vomiting, abdominal pain, stomach fullness, bloating, constipation, diarrhea, straining on urination, straining to stool. Symptom severity was assessed on a 0-4 scale (no=0, mild=1, moderate=2, severe=3, very severe=4). GERD was defined as esophageal acid exposure (AET) >6%.

Results: 69 lung transplant candidates were included, (33.3% female, mean age 63.9±9.1 years, BMI 25.4±4.9 kg/m²). Overall, 21 (30.4%) patients self-reported reflux as a main symptom. 32 (46.4%) patients had GERD (AET >6%): 25% female, mean age 63.8±9.4 compared to 37 (53.6%) patients who did not (AET < 6%): 40.5% were female, mean age 63.9±9.0 (Table 1). When comparing patients with AET < 6% to those with AET >6% using an independent samples t-test, the following mean differences in symptoms severity were observed: SOB (0.41±0.28), coughing (0.11±0.3) and wheezing (-0.44±0.25). Typical GERD symptoms were reported at lower severity overall when compared to SOB, coughing, and wheezing with mean differences between groups as follows: heartburn (0.25±0.26), regurgitation (0.15±0.24), chest pain (0.04±0.23), difficulty swallowing (0.097±0.15). Other GI symptoms mean differences were as follows: belching (0.046±0.23), stomach fullness (0.18±0.23) and hoarseness (-.0078±0.20) (Table 1).

Discussion: GERD symptom severity in lung transplant candidates between patients with objective GERD (AET >6%) was not significantly different from patients without GERD (AET < 6%). Furthermore, reporting of reflux as a main symptom occurred at a lower frequency than MII-pH findings of AET > 6%. This reinforces the importance of esophageal manometry and MII-pH studies in the evaluation of these patients to screen for reflux, which might affect lung transplant rejection. Limitations of these findings include small sample size. Further investigation may be warranted.



Disclosures:


Roshni Bhat, BS¹, Rishabh Khatri, MD², Dariush Shahsavari, MD³, Zubair Malik, MD⁴, Henry P. Parkman, MD⁴. P2395 - Range and Severity of Atypical and Typical Gastroesophageal Reflux Symptoms in Patients Undergoing Lung Transplant Evaluation, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.