RT Journal
A1 Hoppo T, Jarido V, Pennathur A, et al
T1 ANtireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD September 1
VO 146
IS 9
SP 1041
OP 1047
DO 10.1001/archsurg.2011.216
UL http://dx.doi.org/10.1001/archsurg.2011.216
AB 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.