GIANT GASTRIC-ULCERS AND RISK-FACTORS FOR GASTRODUODENAL MUCOSAL DISEASE IN ORTHOTOPIC LUNG-TRANSPLANT PATIENTS

Giant gastric ulcers are defined as ulcers with a diameter greater tha n 3 cm. Previously they have not been described in lung transplant pat ients. We report a high incidence of symptomatic giant gastric ulcers and identify the risk factors for ulcer development in these patients. We examined the records of all 95 patients who had undergone lung tra nsplantation at our institution from November 1991 to July 1995. Fourt een of the patients who underwent lung transplantation developed sympt oms that required esophagogastroduodenoscopy. Three of these patients (21%) were found to have giant gastric ulcers. The relative risk of gi ant gastric ulcer in symptomatic patients undergoing endoscopy after l ung transplantation is over 40 times that of population controls. The patients who developed giant gastric ulcers, despite H-2 antagonist us e, had all received bilateral lung transplantation and had received no nsteroidal antiinflammatory drugs, cyclosporine, and high-dose intrave nous corticosteroids. The risk of developing giant gastric ulcers is s ignificantly increased in patients who have undergone bilateral orthot opic lung transplantation. Clinicians should be made aware of this com plication in order to avoid use of ulcerogenic medications in this pop ulation. Avoidance of these medications could potentially minimize the risk of this complication.