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Goal: The goal of this study was to evaluate the relationship between pretransplant delayed gastric emptying (DGE) and posttransplant acute cellular rejection (ACR) in lung transplant recipients. Background: DGE is very prevalent (23% to 91%) after lung transplantation but pretransplant prevalence has not been well studied. DGE may lead to poor posttransplant outcomes by predisposing to microaspiration. Pretransplant testing for DGE may help identify patients at risk for negative posttransplant outcomes including ACR. Materials and Methods: A retrospective review of a prospectively collected database of consecutive patients undergoing prelung transplant evaluation at a tertiary referral center from 2010 to 2015 was performed. Patients with pretransplant gastric emptying scintigraphy were included in the study. ACR diagnosis was made using International Society for Heart and Lung Transplantation (ISHLT) histologic criteria. Typical gastroparesis symptoms at the time of gastric emptying scintigraphy and pretransplant 24-hour pH impedance monitoring (MII-pH) data was collected. Logistic regression was used for multivariate analysis. Subgroup analyses were performed to account for gastroesophageal reflux (GER). Results: A total of 83 subjects (18 with DGE, 51.8% male, mean age: 53.6 y) met the criteria for inclusion. Patients with DGE were more likely to have typical symptoms of gastroparesis, though 61.1% of DGE patients were asymptomatic. ACR was more prevalent in patients with DGE (33.3% vs. 12.3%, P =0.04). This correlation was independent of GER as measured by MII-pH on subgroup analysis (75% vs. 14.3%, n=0.02). Discussion: Lung transplant recipients with pretransplant DGE have a higher incidence of ACR, independent of GER. Routine pretransplant testing for DGE may help identify patients at greater risk for adverse posttransplant outcomes as the majority of patients with DGE are asymptomatic.

INTRODUCTION: High nursing turnover has long been recognized as a fiscally and emotionally costly phenomenon in gastrointestinal (GI) endoscopy units. Previous studies suggest high turnover may be partly attributed to job-related stress in GI endoscopy units and lack of educational opportunities. A retrospective review of nursing turnover rate in 2016 at Mayo Clinic Florida GI endoscopy unit found the turnover rate to be 25%, which is twice the average of other departments at the clinical site. We aimed to reduce endoscopy staff turnover rate to less than 25% and improve job satisfaction by improving knowledge of GI diseases through structured didactic sessions. METHODS: A descriptive correlational study of the impact of a six-month long optional educational curriculum on professional quality of life and employee turnover was performed. All endoscopy nurses and technicians employed at Mayo Clinic in Florida were recruited, but both study enrollment and participation were blinded and voluntary. Data on clinical gastroenterological knowledge and surveys on professional satisfaction and team cohesion were collected at the initiation of the curriculum and at one month after completion. Pre and post intervention knowledge scores were compared using the Wilcoxon signed rank test. The annual percentage of turnover was estimated by the Wilson score confidence interval. RESULTS: All available GI nurses and endoscopy technicians (n = 71) were invited to participate. 40 (56.3%) participants completed only the initial survey, 30 (42.3%) only the second survey, and 16 (22.9%) both surveys. Of those who completed both surveys, median quiz scores improved by 2 questions for those that attended 6 or more lectures ( P = 0.017). There was a trend towards increased professional satisfaction on the modified perceived cohesion scale in participants who attended 6 or more lectures ( P = 0.095). For participants who have worked in the unit for less than 1 year, the estimated turnover is 14% (6 – 38%, P > 0.05) and 24% (11 – 45%, P >0.05) for those who have worked longer than 1 year. CONCLUSION: Though limited by sample size, there is a trend towards improved job satisfaction for participants that completed all surveys and a reduction in turnover rate for staff who have worked in the unit for less than one year. This study suggests potential benefit in knowledge, professional satisfaction, and turnover for those offered voluntary education.

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) condition involving numerous potential causative factors (e.g. alterations in gut microbiota, motility, brain–gut axis). Several interventions are available for the management of patients with IBS, but no universal management algorithm currently exists. The aim of this article is to review interventions that may be considered in the management of patients with IBS with diarrhea (IBS-D). Nonpharmacological interventions include dietary and lifestyle modification, which are generally used as first-line therapy. Probiotics have demonstrated efficacy and safety in patients with IBS, but studies are inconsistent in strains examined, dosing, and treatment duration. Psychological therapies (e.g. cognitive behavioral therapy, hypnotherapy) also may improve IBS symptoms. Pharmacological interventions for the management of IBS-D include the US Food and Drug Administration–approved agents eluxadoline, rifaximin, and alosetron, as well as loperamide, smooth muscle antispasmodics, bile acid sequestrants, and antidepressants (i.e. tricyclic antidepressants, selective serotonin reuptake inhibitors). Eluxadoline and rifaximin have been shown to improve abdominal pain and stool consistency in patients with IBS-D. In addition, data indicate that alosetron improves IBS symptoms; however, it is approved only for women with severe IBS-D. Of the three approved agents, rifaximin has the most favorable safety profile. The risk–benefit ratio is an important consideration with every medication, but is especially important in the treatment of functional GI disorders such as IBS-D. Thus, the most troublesome symptoms, quality of life, symptom intensity, and individual patient preferences should be considered when formulating a management plan for patients with IBS-D.

Goals: We sought to determine the incidence of jackhammer esophagus (JE) after lung transplantation (LT) and identify potential risk factors for the development of JE after LT. Background: JE is a rare esophageal motility disorder, and its pathophysiology remains unclear. Lung transplantation has been implicated as a potential risk factor for JE, but the incidence of JE after LT is unknown. Study: A retrospective cohort of adult patients who underwent LT at 2 tertiary care centers over 7.5 years was reviewed. Analysis was performed on patients who underwent a high-resolution esophageal manometry (EM) study before and after LT. JE was defined according to the latest Chicago classification, version 3.0. Results: A total of 57 patients without JE identified on pre-LT EM also underwent an EM study after LT. Fifteen (25.4%) were found to have new JE after LT. Patients with newly diagnosed JE after LT were older (61.3±5.3 y vs. 51.6±15.6 y; P=0.02) and more often had chronic obstructive pulmonary disease (COPD; 47.6% vs. 16.6%; P=0.03) compared with those without COPD. There was a trend toward increased risk for JE among female individuals (60% vs. 33.3%; P=0.07) and those with shorter surgical anastomosis times (75.8±12.2 min vs. 84.4±14.3; P=0.06). There was no significant difference between body mass index, opioid use, pretransplant EM findings, surgical ischemic time, occurrence of gastroparesis, or measured post-LT outcomes between the 2 groups. Conclusions: JE occurs not uncommonly in patients after LT. Older age and COPD pre-LT may be significant risk factors.

AbstractAimPatent foramen ovale (PFO) is a common atrial septal defect that is largely asymptomatic and often undiagnosed. The impact of aPFOin patients undergoing liver transplantation (LT) is unknown.ObjectiveAssess the impact ofPFOand physiologic intrapulmonary shunt (IPS) on the perioperative outcomes of patients who underwentLT.MethodsWe performed a retrospective, intention‐to‐treat analysis of patients withPFOand controls withoutPFOwho underwentLTat Mayo Clinic in Florida between 2008 and 2013. Patients with physiologicIPSwere also analyzed. The cohorts were compared for baseline characteristics, length of stay in the intensive care unit (ICU), postoperative oxygen requirements, 30‐d cerebrovascular accidents, and mortality.ResultsOf the 935 patients who underwentLT, 10.4% had provenPFOby pre‐LTechocardiogram. Control patients (n = 101) were statistically older thanPFOandIPS(n = 56) patients, but similar in sex,BMI, Model for End‐stage Liver Disease score, American Society of Anesthesiologist score, and left ventricular ejection fraction.PFOandIPSpatients had similar length of stay in theICU, mechanical ventilation times, post‐LToxygen requirements, and 30‐d mortality compared to controls. Subgroup analysis showed similar outcomes for largePFOandIPSpatients to controls.ConclusionsThe presence ofPFOdid not have a negative impact on perioperativeLToutcomes.