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Gastroparesis: A Harbinger For Obliterative Bronchiolitis Following Heart-Lung Transplantation

Temple University School of Medicine, Philadelphia, PA

PURPOSE: Upper gastrointestinal dysfunction is an unrecognized sequelae after combined heart-lung transplantation (HLT) and may contribute to the development of obliterative bronchiolitis (OB) due to silent aspiration. The purpose of this study was to review the incidence of gastroparesis following HLT and determine its relationship to OB.

METHODS: Seventeen patients who underwent HLT at Temple University Hospital from Jan 1996 to Nov 2002 were retrospectively studied. All survivors greater than one year post-transplant (13/17) were interviewed using questionnaires to evaluate gastrointestinal symptoms (abdominal distension, early satiety, nausea, vomiting, anorexia, dysphagia, heartburn, reflux and regurgitation). All symptomatic patients who failed to improve with medical management underwent pyloroplasty and placement of a feeding tube.

RESULTS: All 13 patients reported onset of gastrointestinal symptoms after HLT (avg, 6.5 mos; range 1 to 31 mos). Six had gastric emptying scans, and all demonstrated delayed gastric emptying (avg, 90.5% of solids retained after 2 hrs; range 73-100%; normal <50%). Four patients responded to medical treatment, and 8 required surgical intervention (7, pyloroplasty; 1, pyloromyotomy) for relief of their symptoms. One patient failed both medical and surgical treatments. The time between HLT and surgery ranged from 1 to 31 mos (avg, 7.1 mos). Prior to the recognition of gastroparesis, as a consequence of HLT, 5 patients developed OB. In this group, 2 responded to medical therapy and 3 required surgical therapy. In these 5, there was no progression of their OB after successful therapy for gastroparesis.

CONCLUSION: The incidence of gastroparesis in our heart lung transplant population is 100%. Successful treatment appears to prevent development of obliterative bronchiolitis and, for those diagnosed with this condition, halt its progression.

CLINICAL IMPLICATIONS: Routine evaluation and treatment of gastroparesis in heart-lung transplant recipients should be aggressively pursued early post transplant to prevent development of obliterative bronchiolitis.

DISCLOSURE: A. Singhal, None.