About 4 months after the retransplantation, the patient first began to
complain of moderately severe heartburn and frequent waterbrash.
Additional testing, therefore, was undertaken. First, an upper GI
endoscopy procedure was performed, which revealed severe, grade 4
erosive esophagitis. The testing of esophageal biopsy specimens was
negative for infection (including stains for viral and fungal
pathogens), which is consistent with acid reflux as the etiology of the
esophagitis. A gastric-emptying study revealed marked gastroparesis
with no appreciable emptying of the tracer at 120 min (for healthy
subjects, the mean gastric emptying is 85% at 120 min). In addition,
an upper GI series was performed that confirmed severe gastroparesis
without mechanical obstruction and also revealed reflux of swallowed
contrast up to the level of the clavicles. Based on these results, the
patient was treated with aggressive medical therapy, which included
lansoprazole (30 mg three times daily) and cisapride (20 mg before
meals and at night).