Investigating Defects of Esophageal Motility in Lung Transplant Recipients.

Background: Lung transplant patients are at risk of developing chronic lung allograft dysfunction (CLAD) of which bronchitis obliterans syndrome (BOS) is the most common. These patients also are noted to develop gastrointestinal (GI) disease. Gastroesophageal reflux disease (GERD) is implicated in BOS, and diagnosis and treatment of GERD may help to decrease incidence of BOS. Methods: A total of 131 lung transplant recipients with post-transplant evaluation between 2012 and 2019 were studied. Of 60 post-transplant evaluations with at least 6 months of post-transplant follow-up that included impedance testing, high-resolution manometry (HRM), and pH testing, procedures were performed according to recognized standards. Results: Of 60 patients, 56 (93%) were alive at 1-year post-transplant. The patients were found to have high rates of GI motility diseases: 37 patients (62%) had abnormal impedance testing, 50 patients (83%) had abnormal HRM results, 22 patients (37%) had abnormal pH test results. There was associated high rejection rates in patients with abnormal esophageal motility. There were 37 patients that had abnormal impedance test results and of those 25 patients (67%) developed rejection. Fifty patients had abnormal post-transplant HRM studies, 33 (66%) had an acute cellular rejection episode. Twenty-two patients had abnormal pH results, with 14 (63%) having an acute cellular rejection. Conclusions: Patients undergoing lung transplantation were found to have increased incidence of abnormal GI motility studies of the esophagus. These patients were further found to have increased rejection rates and BOS which has been associated with worsened mortality. Developing a formalized pre- and post-transplant motility study process, using evolving technologies for these patients, may provide guidance of at-risk patients for CLAD and early treatment to prevent CLAD.

An Algorithmic Approach to Nutritional Difficulties in People With Developmental Disabilities.

With the increasing survival rate of people with developmental disabilities into adulthood and later life, nutritional support and feeding of these individuals frequently becomes a critical problem which must be addressed by their caregivers and healthcare providers. Problems surrounding mealtimes include difficulty with the mechanisms of feeding as well as medical complications including aspiration and gastrointestinal dysmotility. No comprehensive guidelines exist to aid caregivers and healthcare providers regarding the issues in feeding and nutrition in this population. We offer an algorithmic approach to the nutrition-related problems of aspiration, laborious meals and mealtime refusal, choosing the best route for tube feeding, and when to return patients with developmental disabilities back to oral feeding.

Closing the Gaps: Endoscopic Suturing for Large Submucosal and Full-Thickness Defects.

This article is a systematic review of relevant literature on endoscopic suturing as a primary closure technique for large submucosal and full-thickness defects after endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). A comprehensive literature search was conducted through 2016 by using PubMed, to find peer-reviewed original articles. The specific factors considered were the procedural indications and details, success rates, clinical outcomes including complications, and study limitations. Six original articles were included in the final review: two with non-human subjects and four with human subjects. The mean success rate of endoscopic suturing was 97.4% (100% for human subjects and 95.4% for non-human subjects). The procedural time ranged from 7 to 89 min. The average size and depth of lesions were 2.71 cm (3.74 cm [human] and 1.96 cm [non-human]) and 1.52 cm, respectively. The technique itself had no reported impact on mortality. In conclusion, endoscopic suturing is a minimally invasive technique for the primary closure of defects caused by EMR, ESD, and EFTR, with a high success and low complication rate.