Lung transplantation, gastroesophageal reflux, and fundoplication.
Lung transplantation is an accepted treatment strategy for end-stage lung disease; however, bronchiolitis obliterans syndrome is a major cause of morbidity and mortality. This review explores the role of gastroesophageal reflux disease in bronchiolitis obliterans syndrome and the evidence suggesting the benefits of anti-reflux surgery in improving lung function and survival. There is a high prevalence of gastroesophageal reflux in patients post lung transplantation. This may be due to a high preoperative incidence, vagal damage and immunosuppression. Reflux in these patients is associated with a worse outcome, which may be due to micro-aspiration. Anti-reflux surgery is safe in selected lung transplant recipients; however there has been one report of a postoperative mortality. Evidence is conflicting but may suggest a benefit for patients undergoing anti-reflux surgery in terms of lung function and survival; there are no controlled studies. The precise indications, timing, and choice of fundoplication are yet to be defined, and further studies are required.
Robertson
Andrew G N
AG
Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle, United Kingdom.
Ward
Chris
C
Pearson
Jeff P
JP
Corris
Paul A
PA
Dark
John H
JH
Griffin
S Michael
SM
D000328:Adult; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D016040:Lung Transplantation; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*