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

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76 Scopus citations

Abstract

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 (FEV1). 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 FEV1, 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, FEV1 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 FEV1, 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.

Original languageEnglish (US)
Pages (from-to)1041-1047
Number of pages7
JournalArchives of Surgery
Volume146
Issue number9
DOIs
StatePublished - Sep 1 2011

ASJC Scopus subject areas

  • Surgery

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    Hoppo, T., Jarido, V., Pennathur, A., Morrell, M., Crespo, M., Shigemura, N., Bermudez, C., Hunter, J. G., Toyoda, Y., Pilewski, J., Luketich, J. D., & Jobe, B. A. (2011). Antireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation. Archives of Surgery, 146(9), 1041-1047. https://doi.org/10.1001/archsurg.2011.216