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

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