Restoring Esophageal Function: A Case Report on Transcutaneous Electrical Nerve Stimulation for Esophageal Dysmotility Post-Bilateral Lung Transplant

Case Diagnosis: Esophageal dysmotility post bilateral lung transplantation

Case Description or Program Description: A 62-year-old female with acute hypoxemic respiratory failure secondary to idiopathic pulmonary fibrosis underwent bilateral lung transplantation in July 2024, complicated by two failed extubations, with successful extubation two weeks post-transplant. During rehabilitation, she exhibited a weak cough response, mild dysphonia, and reported a globus sensation around the sternum. A fluoroscopic swallow study revealed functional oropharyngeal swallowing but demonstrated retention and retrograde bolus flow below the pharyngoesophageal segment during esophageal sweep, consistent with esophageal dysmotility. In response, transcutaneous electrical nerve stimulation (TENS) was recommended to enhance esophageal motility and aid in respiratory muscle training.

Setting: Acute inpatient rehabilitation

Assessment/Results: The patient received five TENS sessions targeting esophageal retention, each lasting 30-40 minutes. She tolerated the intervention well and was upgraded from a mechanical soft diet to regular solids and thin liquids on discharge. A fluoroscopic swallow study one month post-discharge showed preserved swallow function, safety, and efficiency, with compensatory swallow strategies successfully implemented.

Discussion (relevance): Lung transplant patients are noted to have an increased incidence of abnormal esophageal motility, possibly due to neurological disruption, immunosuppressive medications, or impaired respiratory function. Addressing esophageal dysmotility is essential as studies imply that impaired esophageal motility or refluxed content are important risk factors in the development of chronic lung allograft dysfunction. TENS has been shown to significantly augment the contractile vigor of the esophagus in patients with ineffective esophageal motility. Due to the existing data, it is important to further investigate gastrointestinal motility studies for lung transplantation patients to assist with esophageal function, and to undergo a course of TENS for this specific issue to reduce long-term adverse outcomes.

Conclusions: Esophageal motility should be optimized in patients undergoing lung transplant to decrease the risk of chronic lung allograft dysfunction, and TENS appears to be a valuable modality in improving esophageal function.