Acid, non-acid GER and gastric aspiration in lung transplant patients with or without chronic rejection

¹ Centre for Gastroenterological Research, KULeuven
² Lung Transplant Unit, University Hospital Gasthuisberg, KULeuven, Belgium

	Abstract

Acid gastroesophageal reflux (GER) and gastric aspiration have been labeled as risk factors for chronic rejection (BOS) after lung transplantation (LTx). We aimed to further characterize GER (acid and non-acid) and the degree of gastric aspiration in LTx recipients with and without BOS.

Impedance-pH-recordings were used for GER detection. Pepsin and bile acids levels were measured in BALF.

48% of patients had increased GER of which 27% had exclusively increased non-acid reflux. CF patients had the highest prevalence of GER. Pepsin was found in BALF of all patients and bile acids in BALF of 50% of the patients. Patients with BOS did not have increased GER or elevated pepsin in BALF. However, 70% of the patients with BOS had bile in BALF compared to 31% of stable patients. PPI treatment reduced acid reflux but did not affect non-acid reflux. Moreover, pepsin and bile levels in BALF were not reduced by PPI.

Half of the LTx patients had increased reflux and non-acid reflux was common. Gastric aspiration occurred in most LTx patients. Pepsin was a more general marker and bile acids a more specific marker that might be associated with BOS. PPI treatment did not prevent non-acid reflux and gastric aspiration.

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