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27-09-2011 | Surgery | Article

Antireflux surgery helps preserve lung function before and after transplant

Abstract

Free abstract

MedWire News: Surgery to treat gastroesophageal reflux disease (GERD) helps maintain airway function before and after lung transplantation, according to data published in the Archives of Surgery.

End-stage lung disease, especially in patients with idiopathic pulmonary fibrosis or cystic fibrosis, is often accompanied by GERD. It is also a common problem after lung transplant in these patients, and is associated with bronchiolitis obliterans syndrome (BOS) - an impairment of air flow that is a common cause of death post lung transplant.

"It's possible that reflux, which is due to a weak sphincter between the stomach and the esophagus, allows acid and other gastric juices to leak back not only into the esophagus, but also to get aspirated in small amounts into the lungs," said co-author Blair Jobe, from University of Pittsburgh School of Medicine, Pennsylvania, USA, in a press statement. "That micro-aspiration could be setting the stage for the development of BOS."

Jobe and team reviewed the records of 43 end-stage lung-disease patients who had been evaluated for antireflux surgery (ARS).

Prior to ARS, 44% of the patients had mild or no GERD symptoms but were experiencing clinically silent exposure to gastric fluid. "Based on this finding, there should be a very low threshold for esophageal testing in this patient population," said lead author, Toshitaka Hoppo (University of Pittsburgh).

The cohort included 24 patients who had received a lung transplant and 19 who were being evaluated for transplant. In both groups nearly all measures of lung function improved after ARS; for example, Forced Expiratory Volume in 1 second (FEV1) improved in 91% of post-transplant patients and 85% of the pre-transplant group. The patients with declining FEV1 before ARS showed a reversal of this trend after ARS; this reversal occurred in 92% of the patients in the post-transplant group and 88% of those in the pre-transplant group.

Episodes of pneumonia and acute rejection were also significantly reduced in the post-transplant group and were stabilized for the pre-transplant group. The nine patients with laryngopharyngeal reflux (LPR) prior to ARS had more episodes of acute rejection than the seven patients without LPR - 56% of the patients with LPR experienced acute rejection, compared with 14% of the patients without LPR.

"The surgery appeared to benefit even those who hadn't yet had a transplant," said Jobe. "Given the shortage of donor organs, ARS might help preserve the patient's own function and buy some more time."

By Chloe McIvor

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