Antireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation

Toshitaka Hoppo, Veronica Jarido, Arjun Pennathur, Matthew Morrell, Maria Crespo, Norihisa Shigemura, Christian Bermudez, John G Hunter, Yoshiya Toyoda, Joseph Pilewski, James D Luketich, Blair A Jobe
Archives of Surgery 2011, 146 (9): 1041-7

BACKGROUND: Gastroesophageal reflux disease (GERD) is common in patients with end-stage lung disease (ESLD). GERD may cause obliterative bronchiolitis after lung transplantation (LTx), represented by a decline in forced expiratory volume in 1 second (FEV(1)).

OBJECTIVES: To identify the patterns of reflux in patients with ESLD and to determine whether antireflux surgery (ARS) positively impacts lung function.

DESIGN: Retrospective review of prospectively collected data.

SETTING: Tertiary care university hospital.

PATIENTS: Forty-three patients with ESLD and documented GERD (pre-LTx, 19; post-LTx, 24).

INTERVENTIONS: Antireflux surgery.

MAIN OUTCOME MEASURES: Reflux patterns including laryngopharyngeal reflux as measured by esophageal impedance, and FEV(1), and episodes of pneumonia and acute rejection before and after ARS.

RESULTS: Before ARS, 19 of 43 patients (44%) were minimally symptomatic or asymptomatic. Laryngopharyngeal reflux events, which occurred primarily in the upright position, were common in post-LTx (56%) and pre-LTx (31%) patients. At 1 year after ARS, FEV(1) significantly improved in 91% of the post-LTx patients (P < .01) and 85% of the pre-LTx patients (P = .02). Of patients with pre-ARS declining FEV(1), 92% of post-LTx and 88% of pre-LTx patients had a reversal of this trend. Episodes of pneumonia and acute rejection were significantly reduced in post-LTx patients (P = .03) or stablilized in pre-LTx patients (P = .09).

CONCLUSIONS: There should be a low threshold for performing objective esophageal testing including esophageal impedance because GERD may be occult and ARS may improve or prolong allograft and native lung function.

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