title: 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 (FEV(1)).
  
  
  OBJECTIVE
  To identify the patterns of reflux in patients with ESLD and to determine whether antireflux surgery (ARS) positively impacts lung function.
  
  
  METHODS
  Retrospective review of prospectively collected data.
  
  
  METHODS
  Tertiary care university hospital.
  
  
  METHODS
  Forty-three patients with ESLD and documented GERD (pre-LTx, 19; post-LTx, 24).
  
  
  METHODS
  Antireflux surgery.
  
  
  METHODS
  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.
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA 15232, USA.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Hoppo
authors.forename: Veronica
authors.initials: V
authors.lastname: Jarido
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
authors.forename: Matthew
authors.initials: M
authors.lastname: Morrell
authors.forename: Maria
authors.initials: M
authors.lastname: Crespo
authors.forename: Norihisa
authors.initials: N
authors.lastname: Shigemura
authors.forename: Christian
authors.initials: C
authors.lastname: Bermudez
authors.forename: John G
authors.initials: JG
authors.lastname: Hunter
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
authors.forename: Joseph
authors.initials: J
authors.lastname: Pilewski
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Blair A
authors.initials: BA
authors.lastname: Jobe
mesh_terms: D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D015897:Comorbidity; D003550:Cystic Fibrosis / Q000453:epidemiology; D005260:Female; D005541:Forced Expiratory Volume; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology; D016040:Lung Transplantation; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D011658:Pulmonary Fibrosis / Q000453:epidemiology; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012595:Scleroderma, Systemic / Q000453:epidemiology