The following is a summary of “Tolerability and Feasibility of the Upper Esophageal Sphincter Assist Device in Preventing Acute and Chronic Allograft Rejection Among Lung Transplant Recipients,” published in the July 2023 issue of the Clinical Gastroenterology by Iyer et al.

Researcher’s objective was to assess the effectiveness of a new loaner program for an upper esophageal sphincter (UES) assist device in reducing the risk of acute cellular rejection and chronic lung allograft dysfunction in individuals who have undergone lung transplantation (LTx). Laryngopharyngeal reflux may result in persistent microaspiration and rejection of lung transplantation. The Upper Esophageal Sphincter (UES) assist device exerts external pressure at the level of the UES to reduce reflux. They systematically registered and provided Upper Esophageal Sphincter (UES) assist devices to successive transplant patients referred for gastrointestinal motility testing between 2016 and 2020.

Device tolerability was determined based on the successful transition to ambulatory pH monitoring and antireflux procedure or as a long-term treatment option. The occurrence of rejection was assessed before, during, and after the medical device’s introduction. About 26 participants were provided with medical devices (15 with pathologic conditions, 5 with physiological conditions, and 6 with unknown reflux status), and none of them experienced acute rejection episodes or chronic lung allograft dysfunction during the usage of the device. About 13 individuals readily embraced the medical device shortly after undergoing transplantation (with an average time of 1.7 months). They experienced no rejection throughout an average follow-up period of 24.7 months. 

In individuals with pathological reflux, the duration between the adoption of the medical device and its implementation showed a significant correlation with the occurrence of rejection (r=0.8, P=0.0006). There was no observed correlation among individuals with physiological reflux. Five patients experienced acute rejection following the return of the medical device. The medical device was well-tolerated by most lung transplant (LTx) patients and demonstrates feasibility as a barrier measure in preventing organ rejection. The delayed management of laryngopharyngeal reflux may result in premature allograft failure; hence, it is crucial to carefully consider the utilization of the UES assist device for safeguarding the transplant.

Source: journals.lww.com/jcge/Abstract/2023/07000/Tolerability_and_Feasibility_of_the_Upper.6.aspx