We greatly appreciated the review by Gilljam et al1
(January 2003) on GI complications after lung transplantation in patients with cystic fibrosis (CF). Their experience mirrors our own: distal intestinal obstruction syndrome (DIOS) can be as important an issue after transplant in individuals with CF as management of pulmonary complications. In the initial days after lung transplant, the combination of high-dose narcotics, postoperative ileus, poor oral intake, and bed rest creates a risk for DIOS that makes the estimate of 20% incidence seem optimistically low. Gilljam et al1
wisely suggest “prevention and early medical treatment” to prevent DIOS after transplant, and report success with a routine of early enteral feeding and, if needed, administration of electrolyte GI lavage solution 24 h after transplantation.