What determines the differences in perceptual rating of dysphonia between experienced raters?

BACKGROUND

This systematic review and meta-analysis aimed to quantitatively synthesize the existing evidence to determine the prevalence of oropharyngeal dysphagia (OPD) and gastroesophageal reflux disease (GERD) in lung transplant recipients, identify key risk factors for OPD, and evaluate the impact of GERD on critical clinical outcomes.

METHODS

Strategic searches of several electronic databases such as PubMed, Embase, the Cochrane Library, and Web of Science were performed to find the relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from their inception until December 2025. A random-effects model was applied to compute the prevalence rates. Synthesis of risk factors of OPD and correlation of GERD and clinical outcomes were assessed. The Newcastle-Ottawa Scale was used to evaluate the risk of bias.

RESULTS

A total of 35 studies with 5,245 patients who underwent lung transplantation were included. The analysis revealed that OPD and GERD are highly prevalent after lung transplantation, with pooled prevalence rates of 48% (95% CI [0.41-0.55]) and 43% (95% CI [0.35-0.52]), respectively. Significant risk factors for OPD included mechanical ventilation (OR = 5.37, 95% CI [3.25-8.86]) and reintubation (OR = 2.76, 95% CI [1.29-5.90]). Moreover, the incidence of cystic fibrosis (CF) was significantly higher in patients with GERD compared to non-GERD patients (RR = 1.70, 95% CI [1.16-2.49]). Most importantly, GERD was established as a significant risk factor for the development of bronchiolitis obliterans syndrome (BOS, HR = 2.89, 95% CI [1.35-6.17]).

CONCLUSION

OPD and GERD are prevalent and influence comorbidities among the lung transplant patients. The discovery of particular, modifiable risk factors of OPD and the validation of the importance of GERD in chronic allograft dysfunction contribute to the evidence of the paramount role of preventive screening and management approaches towards both diseases in enhancing patient outcomes.