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.