Short air bubble in the gastric fundus during fasting: radiographic sign of gastroparesis after lung transplantation.

This study was undertaken to assess whether gastroparesis, as a chronic complication of lung transplantation, correlates with height of the gastric air bubble on chest radiographs of erect fasting subjects. Height of the gastric air bubble and presence or absence of a gastric air-fluid level were assessed on chest radiographic examinations (posteroanterior, lateral, upright position, during fasting, immediately after bronchoscopy, median 148 days after transplantation) obtained on 3 separate days for each of 19 recipients of lung transplantation. Seven of the subjects (five women, two men) had chronic upper gastrointestinal symptoms after transplantation and a confirmed diagnosis of gastroparesis. The gastroparesis was idiopathic in six of the subjects and associated with cytomegalovirus gastritis in one subject. The other 12 subjects, each without upper gastrointestinal symptoms, served as controls. Median height of the gastric air bubble was significantly less in the gastroparetic (2.8 cm; range, 1.0-4.6 cm) than in the control (4.7 cm; range, 1.0-12.4 cm) group (p<0.05). Height of the gastric air bubble was at most 4.6 cm among the seven gastroparetic subjects, whereas it exceeded 5.0 cm on at least one occasion in 8 (67%) of the 12 control subjects (p<0.005). The likelihood of a gastric air-fluid level was 86% for symptomatic subjects and 25% for the control group (p<0.01). When lung transplantation is complicated by chronic gastroparesis, postbronchoscopic chest radiographic examinations of fasting subjects are associated with a gastric air bubble limited to high in the fundus, usually including a fluid level.