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David A. Leiman - One of the best experts on this subject based on the ideXlab platform.
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Correction to: Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease
Dysphagia, 2020Co-Authors: Shai Posner, Kurren Mehta, Alice Parish, Donna Niedzwiecki, Rajan T. Gupta, Deborah A. Fisher, David A. LeimanAbstract:The original version of this article unfortunately contained a mistake. The shared first authorship information was missing in the published article. It has been given below. The first authorship is shared between Dr. Shai Posner and Kurren Mehta.
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Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease
Dysphagia, 2020Co-Authors: Shai Posner, Kurren Mehta, Alice Parish, Donna Niedzwiecki, Rajan T. Gupta, Deborah A. Fisher, David A. LeimanAbstract:Gastroesophageal reflux Disease and esophageal dysmotility are common in patients with Advanced Lung Disease (ALD) and are associated with worse outcomes. Assessing esophageal function in these patients is relevant for determining pulmonary transplant eligibility and prognosticating post-transplant outcomes. Barium Swallow (BaS) is a non-invasive testing modality often performed as a complement to formal esophageal function tests (EFTs), but its role and clinical utility in this context is unknown. Therefore, we aimed to determine the relationship between BaS and EFTs with high-resolution manometry (HRM) and 24-h ambulatory pH-metry in patients with ALD. We performed a retrospective study of 226 consecutive patients undergoing evaluation for Lung transplantation at a single center. All patients underwent EFTs and BaS independent of clinical history or symptoms per institutional protocol. Appropriate statistical tests were performed to evaluate the relationship between EFTs and BaS. Mucosal, reflux and motility findings were categorized. Abnormal motility was reported in 133 (59%) patients by BaS and 99 (44%) by HRM, with a significant difference in the proportions of patients with abnormal studies ( p
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esophageal function tests are not associated with barium swallow findings in Advanced Lung Disease
Dysphagia, 2020Co-Authors: Shai Posner, Kurren Mehta, Alice Parish, Donna Niedzwiecki, Rajan T. Gupta, Deborah A. Fisher, David A. LeimanAbstract:Gastroesophageal reflux Disease and esophageal dysmotility are common in patients with Advanced Lung Disease (ALD) and are associated with worse outcomes. Assessing esophageal function in these patients is relevant for determining pulmonary transplant eligibility and prognosticating post-transplant outcomes. Barium Swallow (BaS) is a non-invasive testing modality often performed as a complement to formal esophageal function tests (EFTs), but its role and clinical utility in this context is unknown. Therefore, we aimed to determine the relationship between BaS and EFTs with high-resolution manometry (HRM) and 24-h ambulatory pH-metry in patients with ALD. We performed a retrospective study of 226 consecutive patients undergoing evaluation for Lung transplantation at a single center. All patients underwent EFTs and BaS independent of clinical history or symptoms per institutional protocol. Appropriate statistical tests were performed to evaluate the relationship between EFTs and BaS. Mucosal, reflux and motility findings were categorized. Abnormal motility was reported in 133 (59%) patients by BaS and 99 (44%) by HRM, with a significant difference in the proportions of patients with abnormal studies (p < 0.01). There were 7 (26%) patients with abnormal barium tablet passage who had normal HRM. The sensitivity (35%) and specificity (77%) for detecting pathologic reflux with BaS was poor. Inducibility of reflux and barium column height were not associated with pH-metry results. No clinically significant luminal irregularities were identified. In conclusion, while BaS can non-invasively assess esophageal mucosa, its findings are not associated with EFTs in patients with ALD.
Steven D. Nathan - One of the best experts on this subject based on the ideXlab platform.
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Lung transplantation in IIP: A review.
Respirology (Carlton Vic.), 2015Co-Authors: A. Whitney Brown, Hatice Kaya, Steven D. NathanAbstract:The idiopathic interstitial pneumonias (IIP) encompass a large and diverse subtype of interstitial Lung Disease (ILD) with idiopathic pulmonary fibrosis (IPF) and non-specific interstitial pneumonia (NSIP) being the most common types. Although pharmacologic treatments are available for most types of IIP, many patients progress to Advanced Lung Disease and require Lung transplantation. Close monitoring with serial functional and radiographic tests for Disease progression coupled with early referral for Lung transplantation are of great importance in the management of patients with IIP. Both single and bilateral Lung transplantation are acceptable procedures for IIP. Procedure selection is a complex decision influenced by multiple factors related to patient, donor and transplant centre. While single Lung transplant may reduce waitlist time and mortality, the long-term outcomes after bilateral Lung transplantation may be slightly superior. There are numerous complications following Lung transplantation including primary graft dysfunction, chronic Lung allograft dysfunction (CLAD), infections, gastroesophageal reflux Disease (GERD) and airway Disease that limit post-transplant longevity. The median survival after Lung transplantation is 4.7 years in patients with ILD, which is less than in patients with other underlying Lung Diseases. Although long-term survival is limited, this intervention still conveys a survival benefit and improved quality of life in suitable IIP patients with Advanced Lung Disease and chronic hypoxemic respiratory failure.
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Disease-Specific Considerations for Referral
2015Co-Authors: Steven D. NathanAbstract:The timing of the referral and listing of patients for Lung transplantation remains a difficult decision. Life expectancy and quality of life with and without transplantation are the pivotal issues that need to be considered by physicians and presented to prospective transplant candidates. The recognition of recent advances in the understanding of the various primary Diseases, other potential therapies, and the latest posttransplant statistics are essential for a balanced discussion or decision about Lung transplantation. This article provides a review of these and other pertinent issues for patients with various forms of Advanced Lung Disease. (CHEST 2005; 127:1006–1016)
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Pulmonary hypertension due to Lung Disease and/or hypoxia.
Clinics in chest medicine, 2013Co-Authors: Steven D. Nathan, Paul M. HassounAbstract:Pulmonary hypertension may complicate the course of patients with many forms of Advanced Lung Disease. The cause is likely multifactorial with pathogenic pathways both common and unique to the specific Disease entities. The occurrence of pulmonary hypertension is associated with worse outcomes, but whether this is an adaptive or maladaptive phenomenon remains unknown. The treatment of pulmonary hypertension with vasoactive medications in Lung Disease remains unproved. Specific Disease phenotypes that might benefit, and those in which such therapies might be deleterious, remain to be determined.
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Comorbidities of Advanced Lung Disease.
Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 2009Co-Authors: Joel Anthony Nations, Steven D. NathanAbstract:Lung Disease in Advanced stages is often accompanied by multiple comorbidities. Often, these processes lead to significant morbidity and occasionally mortality. Symptoms of pulmonary comorbidities, including pulmonary embolus, pulmonary hypertension, sleep-disordered breathing, and Lung malignancy, may be intertwined with symptoms of advancing Lung Disease. However, the occurrence of extrapulmonary processes, including depression, diabetes mellitus, osteoporosis, and gastroesophageal reflux Disease, may be subtle. Clinicians caring for Advanced Lung Disease should be aware of the many comorbid processes that may accompany advancing Lung Disease. Mt Sinai J Med 76:53–62, © 2009 Mount Sinai School of Medicine
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Lung Transplantation: Disease-Specific Considerations for Referral
Chest, 2005Co-Authors: Steven D. NathanAbstract:The timing of the referral and listing of patients for Lung transplantation remains a difficult decision. Life expectancy and quality of life with and without transplantation are the pivotal issues that need to be considered by physicians and presented to prospective transplant candidates. The recognition of recent advances in the understanding of the various primary Diseases, other potential therapies, and the latest posttransplant statistics are essential for a balanced discussion or decision about Lung transplantation. This article provides a review of these and other pertinent issues for patients with various forms of Advanced Lung Disease
Don Hayes - One of the best experts on this subject based on the ideXlab platform.
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Influence of Pulmonary Hypertension on Survival in Advanced Lung Disease
Lung, 2015Co-Authors: Don Hayes, Sylvester M. Black, Joseph D. Tobias, Heidi M. Mansour, Bryan A. WhitsonAbstract:Background Effects of pulmonary hypertension (PH) in Advanced Lung Disease remain unclear.
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Pulmonary hypertension in cystic fibrosis with Advanced Lung Disease.
American journal of respiratory and critical care medicine, 2014Co-Authors: Don Hayes, Karen S. Mccoy, Joseph D. Tobias, Heidi M. Mansour, Stephen Kirkby, Curt J. Daniels, Bryan A. WhitsonAbstract:Rationale: The impact of pulmonary hypertension (PH) on survival in cystic fibrosis (CF) remains unclear.Objectives: To determine the influence of PH on survival in the CF population.Methods: The United Network for Organ Sharing database was queried from 1987 to 2013 to identify first-time Lung transplant candidates who were tracked from wait list entry date until death or censoring to determine influence of PH. Using right heart catheterization measurements, mild PH was defined as mean pulmonary artery pressure greater than or equal to 25 mm Hg and severe greater than or equal to 35 mm Hg.Measurements and Main Results: Of 2,781 CF patients, 2,100 were used for univariate analysis, 764 for Kaplan-Meier survival function, 687 for multivariate Cox models, and 576 and 132 for matching on the propensity of mild PH and severe PH, respectively. Univariate Cox analysis found significant differences in survival for mild PH (hazard ratio [HR], 1.747; 95% confidence interval [CI], 1.387–2.201; P < 0.001) and severe...
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Polysomnographic Differences Associated with Pulmonary Hypertension in Patients with Advanced Lung Disease Due to Cystic Fibrosis
Lung, 2014Co-Authors: Don Hayes, Stephen Kirkby, Curt J. Daniels, Benjamin T. Kopp, Kerri L. Nicholson, Ashley E. Nance, Mark SplaingardAbstract:Background Pulmonary hypertension (PH) commonly occurs in patients with cystic fibrosis (CF), but there is no current data regarding alterations of sleep in patients with PH.
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Right heart catheterization measuring central hemodynamics in cystic fibrosis during exercise.
Respiratory medicine, 2013Co-Authors: Don Hayes, Karen S. Mccoy, Heidi M. Mansour, Curt J. Daniels, Benjamin T. Kopp, Andrew R. Yates, Alpa Patel, Stephen KirkbyAbstract:Summary Background Although pulmonary arterial hypertension (PAH) is a potential co-morbidity in cystic fibrosis (CF), right heart catheterization (RHC) is not commonly performed in this patient population until referral for Lung transplantation. Material and methods An non-randomized observational pilot study was performed after an exercise protocol with an upright stationary bicycle was added to RHC performed in patients with CF undergoing evaluation for Lung transplantation (LT). Results Twelve consecutive patients with Advanced Lung Disease due to CF referred for LT completed RHC with exercise protocol. Transthoracic echocardiography (TTE) prior to the RHC did not identify evidence of PAH or significant structural abnormalities; right and left ventricular systolic function were normal. non-randomized RHC in this same cohort found 75% (9/12) had PAH with an elevation of the mean pulmonary artery pressure (PAP) at rest with a mean (±SD) of 27.8 ± 4.9 mmHg that significantly increased during exercise to 47.2 ± 5.4 mmHg, p = 0.0025. For the last 6 patients, pulmonary vascular resistance was calculated during exercise, with a significant increase from 3.15 ± 0.3 to 12.8 ± 0.6 Wood Units (p = 0.0313) comparing measurements at rest to exercise. Conclusion RHC at rest and during exercise was safely and effectively performed in patients with CF referred for LT. Furthermore, central hemodynamic measurements found significant worsening of PAH during exercise in a small cohort of CF patients with Advanced Lung Disease.
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a review of bronchiolitis obliterans syndrome and therapeutic strategies
Journal of Cardiothoracic Surgery, 2011Co-Authors: Don HayesAbstract:Lung transplantation is an important treatment option for patients with Advanced Lung Disease. Survival rates for Lung transplant recipients have improved; however, the major obstacle limiting better survival is bronchiolitis obliterans syndrome (BOS). In the last decade, survival after Lung retransplantation has improved for transplant recipients with BOS. This manuscript reviews BOS along with the current therapeutic strategies, including recent outcomes for Lung retransplantation.
Shai Posner - One of the best experts on this subject based on the ideXlab platform.
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Correction to: Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease
Dysphagia, 2020Co-Authors: Shai Posner, Kurren Mehta, Alice Parish, Donna Niedzwiecki, Rajan T. Gupta, Deborah A. Fisher, David A. LeimanAbstract:The original version of this article unfortunately contained a mistake. The shared first authorship information was missing in the published article. It has been given below. The first authorship is shared between Dr. Shai Posner and Kurren Mehta.
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Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease
Dysphagia, 2020Co-Authors: Shai Posner, Kurren Mehta, Alice Parish, Donna Niedzwiecki, Rajan T. Gupta, Deborah A. Fisher, David A. LeimanAbstract:Gastroesophageal reflux Disease and esophageal dysmotility are common in patients with Advanced Lung Disease (ALD) and are associated with worse outcomes. Assessing esophageal function in these patients is relevant for determining pulmonary transplant eligibility and prognosticating post-transplant outcomes. Barium Swallow (BaS) is a non-invasive testing modality often performed as a complement to formal esophageal function tests (EFTs), but its role and clinical utility in this context is unknown. Therefore, we aimed to determine the relationship between BaS and EFTs with high-resolution manometry (HRM) and 24-h ambulatory pH-metry in patients with ALD. We performed a retrospective study of 226 consecutive patients undergoing evaluation for Lung transplantation at a single center. All patients underwent EFTs and BaS independent of clinical history or symptoms per institutional protocol. Appropriate statistical tests were performed to evaluate the relationship between EFTs and BaS. Mucosal, reflux and motility findings were categorized. Abnormal motility was reported in 133 (59%) patients by BaS and 99 (44%) by HRM, with a significant difference in the proportions of patients with abnormal studies ( p
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esophageal function tests are not associated with barium swallow findings in Advanced Lung Disease
Dysphagia, 2020Co-Authors: Shai Posner, Kurren Mehta, Alice Parish, Donna Niedzwiecki, Rajan T. Gupta, Deborah A. Fisher, David A. LeimanAbstract:Gastroesophageal reflux Disease and esophageal dysmotility are common in patients with Advanced Lung Disease (ALD) and are associated with worse outcomes. Assessing esophageal function in these patients is relevant for determining pulmonary transplant eligibility and prognosticating post-transplant outcomes. Barium Swallow (BaS) is a non-invasive testing modality often performed as a complement to formal esophageal function tests (EFTs), but its role and clinical utility in this context is unknown. Therefore, we aimed to determine the relationship between BaS and EFTs with high-resolution manometry (HRM) and 24-h ambulatory pH-metry in patients with ALD. We performed a retrospective study of 226 consecutive patients undergoing evaluation for Lung transplantation at a single center. All patients underwent EFTs and BaS independent of clinical history or symptoms per institutional protocol. Appropriate statistical tests were performed to evaluate the relationship between EFTs and BaS. Mucosal, reflux and motility findings were categorized. Abnormal motility was reported in 133 (59%) patients by BaS and 99 (44%) by HRM, with a significant difference in the proportions of patients with abnormal studies (p < 0.01). There were 7 (26%) patients with abnormal barium tablet passage who had normal HRM. The sensitivity (35%) and specificity (77%) for detecting pathologic reflux with BaS was poor. Inducibility of reflux and barium column height were not associated with pH-metry results. No clinically significant luminal irregularities were identified. In conclusion, while BaS can non-invasively assess esophageal mucosa, its findings are not associated with EFTs in patients with ALD.
Deborah A. Fisher - One of the best experts on this subject based on the ideXlab platform.
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Correction to: Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease
Dysphagia, 2020Co-Authors: Shai Posner, Kurren Mehta, Alice Parish, Donna Niedzwiecki, Rajan T. Gupta, Deborah A. Fisher, David A. LeimanAbstract:The original version of this article unfortunately contained a mistake. The shared first authorship information was missing in the published article. It has been given below. The first authorship is shared between Dr. Shai Posner and Kurren Mehta.
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Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease
Dysphagia, 2020Co-Authors: Shai Posner, Kurren Mehta, Alice Parish, Donna Niedzwiecki, Rajan T. Gupta, Deborah A. Fisher, David A. LeimanAbstract:Gastroesophageal reflux Disease and esophageal dysmotility are common in patients with Advanced Lung Disease (ALD) and are associated with worse outcomes. Assessing esophageal function in these patients is relevant for determining pulmonary transplant eligibility and prognosticating post-transplant outcomes. Barium Swallow (BaS) is a non-invasive testing modality often performed as a complement to formal esophageal function tests (EFTs), but its role and clinical utility in this context is unknown. Therefore, we aimed to determine the relationship between BaS and EFTs with high-resolution manometry (HRM) and 24-h ambulatory pH-metry in patients with ALD. We performed a retrospective study of 226 consecutive patients undergoing evaluation for Lung transplantation at a single center. All patients underwent EFTs and BaS independent of clinical history or symptoms per institutional protocol. Appropriate statistical tests were performed to evaluate the relationship between EFTs and BaS. Mucosal, reflux and motility findings were categorized. Abnormal motility was reported in 133 (59%) patients by BaS and 99 (44%) by HRM, with a significant difference in the proportions of patients with abnormal studies ( p
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esophageal function tests are not associated with barium swallow findings in Advanced Lung Disease
Dysphagia, 2020Co-Authors: Shai Posner, Kurren Mehta, Alice Parish, Donna Niedzwiecki, Rajan T. Gupta, Deborah A. Fisher, David A. LeimanAbstract:Gastroesophageal reflux Disease and esophageal dysmotility are common in patients with Advanced Lung Disease (ALD) and are associated with worse outcomes. Assessing esophageal function in these patients is relevant for determining pulmonary transplant eligibility and prognosticating post-transplant outcomes. Barium Swallow (BaS) is a non-invasive testing modality often performed as a complement to formal esophageal function tests (EFTs), but its role and clinical utility in this context is unknown. Therefore, we aimed to determine the relationship between BaS and EFTs with high-resolution manometry (HRM) and 24-h ambulatory pH-metry in patients with ALD. We performed a retrospective study of 226 consecutive patients undergoing evaluation for Lung transplantation at a single center. All patients underwent EFTs and BaS independent of clinical history or symptoms per institutional protocol. Appropriate statistical tests were performed to evaluate the relationship between EFTs and BaS. Mucosal, reflux and motility findings were categorized. Abnormal motility was reported in 133 (59%) patients by BaS and 99 (44%) by HRM, with a significant difference in the proportions of patients with abnormal studies (p < 0.01). There were 7 (26%) patients with abnormal barium tablet passage who had normal HRM. The sensitivity (35%) and specificity (77%) for detecting pathologic reflux with BaS was poor. Inducibility of reflux and barium column height were not associated with pH-metry results. No clinically significant luminal irregularities were identified. In conclusion, while BaS can non-invasively assess esophageal mucosa, its findings are not associated with EFTs in patients with ALD.