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Antireflux Surgery Preserves Lung Function in Patients With Gastroesophageal Reflux Disease and End-stage Lung Disease Before and After Lung Transplantation.
MedLine Citation:
PMID:  21931001     Owner:  NLM     Status:  In-Data-Review    
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.
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
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  146     ISSN:  1538-3644     ISO Abbreviation:  Arch Surg     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1041-7     Citation Subset:  AIM; IM    
Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Shadyside Medical Center, Ste 715, 5200 Centre Ave, Pittsburgh, PA 15232.
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