Gastrointestinal complications and endoscopic findings in heart transplant patients.

To determine the scope of gastrointestinal complications in heart transplant recipients, we examined the frequency and nature of gastrointestinal complications by reviewing the indications and findings of endoscopic and surgical procedures involving the gastrointestinal tract in 159 patients. All patients were treated with prednisone, azathioprine, and cyclosporine after transplantation. Sixty-seven patients (42%) had gastrointestinal symptoms significant enough to warrant either endoscopic, radiologic, or surgical procedures. Forty-seven patients (30%) underwent esophagogastroduodenoscopy or upper gastrointestinal roentgenography with a high frequency of esophagitis, gastritis, duodenitis, and gastroduodenal ulcers. Thirty-two patients (20%) underwent barium enema or endoscopic procedures of the lower gastrointestinal tract, with the most frequent findings being benign polyps and colitis. Opportunistic infections, especially with cytomegalovirus, were frequent and were only diagnosed by endoscopic procedures, indicating an advantage of endoscopy over barium studies in these patients. Twenty-three patients (15%) underwent surgical procedures for gastrointestinal complications with 2.5% mortality. Hence, significant gastrointestinal complications that are common in heart transplant recipients, can be safely managed surgically when surgical intervention is indicated.

Prevalence and management of cholelithiasis in heart transplant patients.

There is no accepted approach in the field of heart transplantation for the management of asymptomatic cholelithiasis. To help formulate a strategy, we retrospectively reviewed the records of the 159 patients who underwent heart transplantation at our institution from March 1984 to January 1990. Information on the biliary tract was available in 141 (88.7%) of these patients. Before transplantation, 18 (11.3%) had undergone cholecystectomy. Of the 141, 99 (70.2%) had undergone ultrasonographic examination of the biliary tree: 74 (74.8%) had no gallstones seen on ultrasonograms; 8 (8.1%) had sludge; 16 (16.2%) had gallstones; and 1 had a probable polyp. Further information on the biliary tree by ultrasonography became available after transplantation in 24 of 42 patients who did not undergo ultrasonographic examination before transplant. After transplant, gallstones were found by means of ultrasonography or at autopsy in 13 more patients. Seven (4.4%) patients underwent cholecystectomy after transplant because of symptomatic cholelithiasis. Only one of these patients belonged to the group known to have gallstones before transplant. For the entire group, the prevalence of cholelithiasis was 29.6%. Multivariate analysis demonstrated that gallstones were significantly more common in older patients. We conclude that the prevalence of cholelithiasis in the heart transplant population is high but that only a minority of patients with asymptomatic gallstones will become symptomatic after heart transplantation. When they do, cholecystectomy may be safely performed. Prophylactic cholecystectomy and screening ultrasonography are not indicated in patients with asymptomatic cholelithiasis.

Canine gastric muscarinic receptors up-regulate after vagotomy.

Postvagotomy (PV) gastroparesis is an infrequent but troublesome problem. To test the hypothesis that the rarity of the PV syndrome is due to compensatory up-regulation of muscarinic cholinergic receptors (mAChR), we measured changes in stomach mAChR and gastric acid secretion in dogs before and three weeks after truncal vagotomy. Maximum acid output dropped significantly one week PV and then partially recovered by three weeks PV. mAChR density changed in parallel and was significantly increased in body mucosa, body muscle, and antrum mucosa. In the body, changes in mAChR in mucosa correlated positively with changes in muscle, suggesting that mAChR binding in pinch biopsies of gastric mucosa might become useful in evaluating patients for postvagotomy syndrome. PV up-regulation of mAChR in the mucosa of the canine gastric body might explain PV recovery of gastric acid secretion.