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Gastroesophageal reflux disease and the lung transplant recipient

  • Lung Transplate (M Zamora, Section Editor)
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Abstract

Lung transplantation is today a valid treatment for end-stage lung disorders, although long-term survival is still limited by chronic lung allograft dysfunction (CLAD). Repeat evidence has indicated gastroesophageal reflux and consequent retrograde chronic and silent microaspiration as a non-alloimmunogenic inflammatory risk factor for CLAD and/or bronchiolitis obliterans syndrome (BOS). Unfortunately, to date a gold standard methodology for detecting penetrance of refluxed duodenogastric secretions into the lung is lacking, and a definitive marker of retrograde microaspiration secondary to gastroesophageal reflux that identifies patients at risk for lung allograft dysfunction needs to be determined. Appropriately, designed clinical trials should be performed to understand better the role of gastroesophageal reflux in CLAD and/or BOS and to identify appropriate treatment algorithms.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance • Of major importance

  1. Christie JD, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult lung and heart-lung transplant report–2010. J Heart Lung Transplant. 2010;29:1104–18.

    Article  PubMed  Google Scholar 

  2. Verleden GM, Vos R, De Vleeschauwer SI, et al. Obliterative bronchiolitis following lung transplantation: from old to new concepts? Transpl Int. 2009;22(8):771–9.

    Article  PubMed  Google Scholar 

  3. Robertson AG, Griffin SM, Murphy D, et al. Targeting allograft injury and inflammation in the management of post-lung transplant bronchiolitis obliterans syndrome. Am J Transplant. 2009;9:1272–8.

    Article  CAS  PubMed  Google Scholar 

  4. Robertson AG, Ward C, Pearson JP, et al. Lung transplantation, gastroesophageal reflux and fundoplication. Ann Thorac Surg. 2010;89:653–60.

    Article  PubMed  Google Scholar 

  5. Hadjiliadis D, Duane DR, Steele MP, et al. Gastroesophageal reflux disease in lung transplant recipients. Clin Transplant. 2003;17:363–8.

    Article  PubMed  Google Scholar 

  6. Benden C, Aurora P, Curry J, et al. High prevalence of gastroesophageal reflux in children after lung transplantation. Pediatr Pulmonol. 2005;40:68–71.

    Article  PubMed  Google Scholar 

  7. Pearson JEG, Wilson RSE. Diffuse pulmonary fibrosis and hiatus hernia. Thorax. 1971;26:300–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Belsey R. The pulmonary complications of dysphagia. Thorax. 1948;4:44–56.

    Google Scholar 

  9. Davis MV. Evolving concepts regarding hiatus hernia and gastroesophageal reflux. Ann Thorac Surg. 1969;7:120–33.

    Article  CAS  PubMed  Google Scholar 

  10. Paulson DL. Reflux respiratory threat called unappreciated. US Med. 1972;4:32.

    Google Scholar 

  11. Orringer MB, Skinner DB, Belsey RHR. Long term results of the Mark IV operation for hiatal hernia and analysis of recurrences and their treatment. J Thorac Cardiovasc Surg. 1972;63:25–31.

    CAS  PubMed  Google Scholar 

  12. Sadoun D, Valeyre D, Cargill J, Volter F, Amouroux J, Battesti JP. Bronchiolitis obliterans with cryptogenetic-like organizing pneumonia. Demonstration of gastroesophageal reflux in 5 cases. Presse Med. 1988;17:2383–5.

    CAS  PubMed  Google Scholar 

  13. Osler WB. Bronchial asthma. The principles and practice of medicine. New York: Appleton; 1892. p. 497–501.

    Google Scholar 

  14. Mays EE, Dubois JJ, Hamilton GB. Pulmonary fibrosis with tracheobronchial aspiration. Chest. 1976;69:512–5.

    Article  CAS  PubMed  Google Scholar 

  15. Feigelson J, Girault F, Pecau Y. Gastro-oesophageal reflux and esophagitis in cystic fibrosis. Acta Paediatr Scand. 1987;76:989–90.

    Article  CAS  PubMed  Google Scholar 

  16. Tobin RW, Pope 2nd CE, Pellegrini CA, Emond MJ, Sillery J, Raghu G. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1998;158:1804–8.

    Article  CAS  PubMed  Google Scholar 

  17. Ahrens P, Weimer B, Hofmann D. Severe interstitial lung disease from pathologic gastroesophageal reflux in children. Pneumologie. 1999;53:569–72.

    Google Scholar 

  18. Ing AJ. Interstitial lung disease and gastroesophageal reflux. Am J Med. 2001;111:41s–4.

    Article  PubMed  Google Scholar 

  19. Herbst JJ, Minton SD, Book LS. Gastroesophageal reflux causing respiratory distress and apnea in newborn infants. J Pediatr. 1979;95:763.

    Article  CAS  PubMed  Google Scholar 

  20. Sontag SJ, Schnell TG, Miller Q, et al. Prevalence of oesophagitis in asthmatics. Gut. 1992;33:872–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. D’Ovidio F, Keshavjee S. Gastroesophageal reflux and lung transplantation. Dis Esophagus. 2006;19:315–20.

    Article  PubMed  Google Scholar 

  22. Raviv Y, D'Ovidio F, Pierre A, Chaparro C, Freeman M, Keshavjee S, et al. Prevalence of gastroparesis before and after lung transplantation and its association with lung allograft outcomes. Clin Transplant. 2012;26(1):133–42. This study shows that gastroparesis, as measured by nuclear gastric emptying test for solids, is highly prevalent and severe in lung-transplant candidates and recipients. The association between gastric emptying and CLAD, was significant inpatients with gastroparesis before transplantation, suggesting that early intervention may be beneficial in preventing CLAD.

    Article  PubMed  Google Scholar 

  23. Bodet-Milin C, Querellou S, Oudoux A, et al. Delayed gastric emptying scintigraphy in cystic fibrosis patients before and after lung transplantation. J Heart Lung Transplant. 2006;25:1077.

    Article  PubMed  Google Scholar 

  24. Marie I, Levesque H, Ducrotte P, et al. Gastric involvement in systemic sclerosis: a prospective study. Am J Gastroenterol. 2001;96:77.

    Article  CAS  PubMed  Google Scholar 

  25. Harding SM. Nocturnal asthma: role of gastroesophageal reflux. Chronobiol Int. 1999;16:641.

    Article  CAS  PubMed  Google Scholar 

  26. Schiller LR. Upper gastrointestinal motility disorders and respiratory symptoms. Am J Health Syst Pharm. 1996;53(22 Suppl 3):S13.

    CAS  PubMed  Google Scholar 

  27. Fisher RS. Gastroduodenal motility disturbances in man. Scand J Gastroenterol Suppl. 1985;109:59.

    Article  CAS  PubMed  Google Scholar 

  28. Samson M, Vermeijden JR, Smout AJ. Prevalence of delayed gastric emptying in diabetic patients and relationship to dyspeptic symptoms: a prospective study in unselected diabetic patients. Diabetes Care. 2003;26:116.

    Google Scholar 

  29. Samson M, Akkermans LM, Jebbink RJ, Van Isselt H, Van Berge-Henegouwen GP, Smout AJ. Gastrointestinal motor mechanisms in hyperglycemia induced delayed gastric emptying type I diabetes mellitus. Gut. 1997;40:641.

    Article  Google Scholar 

  30. American Gastroenterological Association Clinical Practice Committee. Gastroenterology. 2004;127:1592–162.

    Article  Google Scholar 

  31. Young LR, Hadjiliadis D, Davis RD, Palmer SM. Lung transplantation exacerbates gastroesophageal reflux disease. Chest. 2003;124:1689–93.

    Article  PubMed  Google Scholar 

  32. Blondeau K, Mertens V, Vanaudenaerde BA, et al. Nocturnal weakly acidic reflux promotes aspiration of bile acids in lung transplant recipients. J Heart Lung Transplant. 2009;28:141–8.

    Article  PubMed  Google Scholar 

  33. King BJ, Iyer H, Leidi AA, Carby MR. Gastroesophageal reflux in bronchiolitis obliterans syndrome: a new perspective. J Heart Lung Transplant. 2009;28:870–5.

    Article  PubMed  Google Scholar 

  34. Au J, Hawkins T, Venables C, et al. Upper gastrointestinal dysmotility in heart-lung transplant recipients. Ann Thorac Surg. 1993;55:94–7.

    Article  CAS  PubMed  Google Scholar 

  35. D’Ovidio F, Mura M, Tsang M, et al. Bile acid aspiration and the development of bronchiolitis obliterans after lung transplantation. J Thorac Cardiovasc Surg. 2005;129:1144–52.

    Article  PubMed  Google Scholar 

  36. D’Ovidio F, Mura M, Waddell TK, et al. Bile acids in bronchoalveolar lavage after lung transplantation as a marker of pulmonary aspiration associated with alveolar neutrophilia. J Heart Lung Transplant. 2004;23(2, Suppl 1):42S.

    Article  Google Scholar 

  37. D’Ovidio F, Mura M, Ridsdale R, et al. The effect of reflux and bile acid aspiration on the lung allograft and its surfactant and innate immunity molecules SP-A and SP-D. Am J Transplant. 2006;6:1930–8.

    Article  PubMed  Google Scholar 

  38. Irwin RS, Richter JE. Gastroesophageal reflux and chronic cough. Am J Gastroenterol. 2000;95:S 9–14.

    Article  CAS  Google Scholar 

  39. Irwin RS, Curley FJ, French CL. Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis. 1990;141:640–7.

    Article  CAS  PubMed  Google Scholar 

  40. Sweet MP, Patti MG, Leard LE, Golden JA, Hays SR, Hoopes C, et al. Gastroesophageal reflux in patients with idiopathic pulmonary fibrosis referred for lung transplantation. J Thorac Cardiovasc Surg. 2007;133:1078–84.

    Article  PubMed  Google Scholar 

  41. Hoppo T, Jarido V, Pennathur A, Morrell M, Crespo M, Shigemura N, et al. Antireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation. Arch Surg. 2011;146:1041–7.

    Article  PubMed  Google Scholar 

  42. Blondeau K, Mertens V, Vanaudenaerde BA, Verleden GM, Van Raemdonck DE, Sifrim D, et al. Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection. Eur Respir J. 2008;31:707–13.

    Article  CAS  PubMed  Google Scholar 

  43. Ghaed N, Stein M. Assessment of a technique for scintigrafic monitoring of pulmonary aspiration of gastric contents in asthmatics with gastroesophageal reflux. Ann Allergy. 1979;42:306.

    CAS  PubMed  Google Scholar 

  44. Patti MG, Debas HT, Pellegrini CA. Esophageal manometry and 24-hour pH monitoring in the diagnosis of pulmonary aspiration secondary to gastroesophageal reflux. Am J Surg. 1992;163:401–6.

    Article  CAS  PubMed  Google Scholar 

  45. Potluri S, Friedenberg F, Parkman HP, et al. Comparison of a salivary/sputum pepsin assay with 24-hour esophageal pH monitoring for detection of gastric reflux into the proximal esophagus, oropharynx and lung. Dig Dis Sci. 2003;48:1813–7.

    Article  CAS  PubMed  Google Scholar 

  46. Reid KR, McKenzie FN, Menkis AH, et al. Importance of chronic aspiration in recipients of heart-lung transplants. Lancet. 1990;336:206–8.

    Article  CAS  PubMed  Google Scholar 

  47. Kirk AJ, Colquhoun IW, Corris PA, Hilton CJ, Dark JH. Impaired gastrointestinal motility in pulmonary transplantation. Lancet. 1990;336:752.

    Article  CAS  PubMed  Google Scholar 

  48. Lubetkin EI, Lipson DA, Palevsky HI, et al. GI complications after lung transplantation. Am J Gastroenterol. 1996;91:2382–90.

    CAS  PubMed  Google Scholar 

  49. Berkowitz H, Schulman LL, McGregor C, et al. Gastroparesis after lung transplantation-potential role in postoperative respiratory complications. Chest. 1995;108:1062–607.

    Article  Google Scholar 

  50. Reich SB, Earley WC, Ravin TH, Goodman M, Spector S, Stein MR. Evaluation of gastropulmonary aspiration by a radioactive technique. J Nucl Med. 1977;18:1079.

    CAS  PubMed  Google Scholar 

  51. Gleeson K, Eggli DF, Maxwell SL. Quantitative aspiration during sleep in normal subjects. CHEST. 1997;111:1266–72.

    Article  CAS  PubMed  Google Scholar 

  52. Chernow B, Johnson LF, Janowitz WR, Castell DO. Pulmonary aspiration as a consequence of gastroesophageal reflux: a diagnostic approach. Dig Dis Sci. 1979;24:839–44.

    Article  CAS  PubMed  Google Scholar 

  53. Metheny NA, Chang YH, Song J, et al. Pepsin as a marker for pulmonary aspiration. Am J Critical Care. 2002;11:150–4.

    Google Scholar 

  54. Nussbaum E, Maggi JC, Mathis R, Galant SP. Association of lipid-laden alveolar macrophages and gastro-esophageal reflux in children. Pediatr. 1987;110:190.

    Article  CAS  Google Scholar 

  55. Halsey KD, Wald A, Meyer KC, et al. Non-acidic supraesophageal reflux associated with diffuse alveolar damage and allograft dysfunction after lung transplantation: a case report. J Heart Lung Transplant. 2008;27:564–7.

    Article  PubMed  Google Scholar 

  56. D’Ovidio F, Waddell T, Singer LG, et al. Spontaneous reversal of acid GER after lung transplantation. J Heart Lung Transplant. 2008;27(2S):S109.

    Article  Google Scholar 

  57. Tamhankar AP, Peters JH, Portale G, et al. Omeprazole does not reduce gastroesophageal reflux: new insights using multichannel intraluminal impedence technology. J Gastrointest Surg. 2004;8:888–96.

    Article  Google Scholar 

  58. Hartwig MG, Appel JZ, Li B, et al. Chronic aspiration of gastric fluid accelerates pulmonary allograft dysfunction in a rat model of lung transplantation. JTCVS. 2005;131:209–17.

    Google Scholar 

  59. Effros R, Jacobs ER, Schapira RM, Biller J. Response of the lungs to aspiration. Am J Med. 2001;111:15S–9.

    Article  Google Scholar 

  60. Effros RM, Hogan G, Hoagland KW, Olson L, Lin W. Protection of the lungs from acid during aspiration. Am J Med. 2001;111:56S–9.

    Article  PubMed  Google Scholar 

  61. Mattioli S, Felice V, Pastina M, et al. Duodenogastric and non acid gastro-oesophageal reflux in patients with reflux opesophagitis. Hepato-Gastroenterology. 1995;42:360–6.

    CAS  PubMed  Google Scholar 

  62. Emerenziani S, Sifrim D. New developments in detection of gastroesophageal reflux. Curr Opin Gastroenterol. 2005;21:450–3.

    PubMed  Google Scholar 

  63. Oelschlager BK, Chang L, Pope 2nd CE, Pellegrini CA. Typical GERD symptoms and esophageal pH monitoring are not enough to diagnose pharyngeal re fl ux. J Surg Res. 2005;128:55–60.

    Article  PubMed  Google Scholar 

  64. Tutuian R. Update in the diagnosis of gastroesophageal reflux disease. J Gastrointest Liver Dis. 2006;15:243–7.

    Google Scholar 

  65. Kahrilas PJ, Sifrim D. High-resolution manometry and impedance-pH/manometry: valuable tools in clinical and investigational esophagology. Gastroenterology. 2008;135:756–69.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Vaezi MF, Richter JE. Duodenogastroesophageal reflux and methods to monitor nonacidic reflux. Am J Med. 2001;111(8A):160S–8.

    Article  PubMed  Google Scholar 

  67. Hopkins PM, Kermeen F, Duhig E, Fletcher L, Gradwell J, Whitfield L, et al. Oil red O stain of alveolar macrophages is an effective screening test for gastroesophageal reflux disease in lung transplant recipients. J Heart Lung Transplant. 2010;29:859–64.

    Article  PubMed  Google Scholar 

  68. Ward C, Forrest IA, Brownlee IA, Johnson GE, Murphy DM, Pearson JP, et al. Pepsin like activity in bronchoalveolar lavage fluid is suggestive of gastric aspiration in lung allografts. Thorax. 2005;60:872–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  69. Stovold R, Forrest IA, Corris PA, Murphy DM, Smith JA, Decalmer S, et al. Pepsin, a biomarker of gastric aspiration in lung allografts: a putative association with rejection. Am J Respir Crit Care Med. 2007;175:1298–303.

    Article  CAS  PubMed  Google Scholar 

  70. Vos R, Blondeau K, Vanaudenaerde BM, Mertens V, Van Raemdonck DE, Sifrim D, et al. Airway colonization and gastric aspiration after lung transplantation: do birds of a feather flock together? J Heart Lung Transplant. 2008;27:843–9.

    Article  PubMed  Google Scholar 

  71. Shimizu Y, Dobashi K, Nagoshi A, Kawamura O, Mori M. Assessment of airway inflammation by exhaled breath condensate and impedance due to gastroesophageal reflux disease (GERD). Inflamm Allergy Drug Targets. 2009;8:292–6.

    Article  CAS  PubMed  Google Scholar 

  72. Davis CS, Gagermeier J, Dilling D, Alex C, Lowery E, Kovacs EJ, et al. A review of the potential applications and controversies of non-invasive testing for biomarkers of aspiration in the lung transplant population. Clin Transplant. 2010;24:E54–61. This review discusses the potential role of gastro-esophageal reflux and microaspiration in the development of post-transplant allograft dysfunction, examining the potential strategies to manage transplant recipients with evidence of gastroesophageal reflux.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  73. Yates DH, Krishnan A, Chow S, Thomas PS. Non-invasive assessment of exhaled biomarkers in lung transplantation. J Breath Res. 2011;5:024001.

    Article  PubMed  Google Scholar 

  74. Jackson AS, Sandrini A, Campbell C, Chow S, Thomas PS, Yates DH. Comparison of biomarkers in exhaled breath condensate and bronchoalveolar lavage. Am J Respir Crit Care Med. 2007;175:222–7.

    Article  CAS  PubMed  Google Scholar 

  75. Dupont LJ, Dewandeleer Y, Vanaudenaerde BM, Van Raemdonck DE, Verleden GM. The pHof exhaled breath condensate of patients with allograft rejection after lung transplantation. Am J Transplant. 2006;6:1486–92.

    Article  CAS  PubMed  Google Scholar 

  76. Soter S, Kelemen K, Barta I, Valyon M, Csiszer E, Antus B. Exhaled breath condensate pH in lung transplant recipients with bronchiolitis obliterans syndrome. Transplantation. 2011;91:793–7.

    PubMed  Google Scholar 

  77. Gautam A. Gastrointestinal complications following transplantation. Surg Clin N Am. 2006;86:1195–206.

    Article  PubMed  Google Scholar 

  78. Oelberg DG, Downey SA, Flynn MM, Oelberg DG, Downey SA, Flynn MM. Bile salt-induced intracellular Ca++ accumulation in type II pneumocytes. Lung. 1990;168:297–308.

    Article  CAS  PubMed  Google Scholar 

  79. Jarmuz T, Roser S, Rivera H, Gal A, Roman J. Transforming growth factor-beta1, myofibroblasts, and tissue remodeling in the pathogenesis of tracheal injury: potential role of gastroesophageal reflux. Ann Otol Rhinol Laryngol. 2004;113:488–97.

    Article  PubMed  Google Scholar 

  80. Li B, Hartwig MG, Appel JZ, et al. Chronic aspiration of gastric fluid induces the development of obliterative bronchiolitis in rat lung transplants. Am J Transplant. 2008;8:1614–21.

    Article  CAS  PubMed  Google Scholar 

  81. Fink SM, Lange RC, McCallum RW. Effect of metoclopramideon normal and delayed gastric emptying in gastroesophageal reflux patients. Dig Dis Sci. 1983;28:1057–61.

    Article  CAS  PubMed  Google Scholar 

  82. Mansi C, Borro P, Giacomini M, et al. Comparative effects of levosulpiride and cisapride on gastric emptying and symptoms in patients with functional dyspepsia and gastroparesis. Aliment Pharmacol Ther. 2000;14:561–9.

    Article  CAS  PubMed  Google Scholar 

  83. Takeda T, Konomi H, Naritomi G, et al. Single oral dose of cisapride accelerates gastric antral emptying in healthy humans: an ultrasonographic study. J Gastroenterol. 1996;31:323–8.

    Article  CAS  PubMed  Google Scholar 

  84. Netzer P, Schmitt B, Inauen W. Effects of ABT-229, a motilin agonist, on acid reflux, oesophageal motility and gastric emptying in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2002;16:1481–90.

    Article  CAS  PubMed  Google Scholar 

  85. Mertens V, Blondeau K, Pauwels A, et al. Azithromycin reduces gastroesophageal reflux and aspiration in lung transplant recipients. Dig Dis Sci. 2009;54:972–9.

    Article  CAS  PubMed  Google Scholar 

  86. Davis Jr RD, Lau CL, Eubanks S, et al. Improved lung allograft function after fundoplication in patients with gastroesophageal reflux disease undergoing lung transplantation. J Thorac Cardiovasc Surg. 2003;125:533.

    Article  PubMed  Google Scholar 

  87. Cantu III E, Appel III JZ, Hartwig MG, et al. J. Maxwell Chamberlain Memorial Paper. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease. Ann Thorac Surg. 2004;78:1142–51.

    Article  PubMed  Google Scholar 

  88. Fisichella PM, Davis CS, Shankaran V, et al. The prevalence and extent of gastroesophageal reflux disease correlates to the type of lung transplantation. Surg Laparosc Endosc Percutan Tech. 2012;22:46–51.

    Article  PubMed Central  PubMed  Google Scholar 

  89. Robertson AGN, Krishnan A, Ward C, et al. Anti-reflux surgery in lung transplant recipients: outcomes and effects on quality of life. Eur Respir J. 2012;39:691–7. This paper describes supports the concept that antireflux fundoplication in selected patients, may improve symptoms, quality of life, and may reduce deterioration of lung function.

    Article  CAS  PubMed  Google Scholar 

  90. Ghadi NA, Kumar S, Cheung B, et al. Anti-reflux surgery for lung transplant recipients in the presence of impedance-detected duodenogastroesophageal reflux and bronchiolitis obliterans syndrome: a study of efficacy and safety. J Heart Lung Transplant. 2013;32(6):588–95.

    Article  Google Scholar 

  91. Fisichella PM, Davis CS, Gagermeier J, et al. Laparoscopic antireflux surgery for gastroesophageal reflux disease after lung transplantation. J Surg Res. 2011;170:279–86. This case-control study on the pathophysiologic characteristics of GERD in lung transplant patients, and also the second largest institutional series describing laparoscopic antireflux surgery for GERD after lung transplantation. The study suggests that lung transplant patients rarely have a hiatal hernia and have more frequent and severe proximal reflux.

    Article  Google Scholar 

  92. Fisichella PM, Davis CS, Lundberg PW, et al. The protective role of laparoscopic antireflux surgery against aspiration of pepsin after lung transplantation. Surgery. 2011;150:598–606. This study suggeststhat laparoscopic antireflux surgery is effective in preventing aspiration as defined by the presence of pepsin in the bronchoalveolar lavage fluid. Therefore antireflux surgery may prevent nonallogenic injury to the transplanted lungs from aspiration of gastroesophageal contents.

    Article  PubMed Central  PubMed  Google Scholar 

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Both Dr. Beatrice Aramini and Dr. Frank D’Ovidio have no reported conflict of interests.

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences for Children and Adults, General Thoracic Surgery Postgraduate Program, University of Modena and Reggio Emilia, 64, Corso Canal Grande, 41121, Modena, Italy

    Beatrice Aramini

  2. Department of Surgery, Section of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, Admitting Dept 1st floor, 173 Fort Washington Ave, New York, NY, 10032, USA

    Frank D’Ovidio

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  1. Beatrice Aramini
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Aramini, B., D’Ovidio, F. Gastroesophageal reflux disease and the lung transplant recipient. Curr Respir Care Rep 3, 206–213 (2014). https://doi.org/10.1007/s13665-014-0092-2

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