title: How useful is antireflux surgery in lung transplant patients with gastroesophageal reflux?
abstract: OBJECTIVE
  Respiratory function deteriorates over time after lung transplant. Reflux disease with pulmonary complications is a possible cause of this decline. This case series we aim to assess whether respiratory function improves after Nissen fundoplication in lung transplant patients and if surgery reduces gastroesophageal reflux disease (GERD) symptoms and use of proton pump inhibitors (PPIs).
  
  
  METHODS
  A retrospective case series of lung transplant patients with reflux disease and Nissen fundoplication. Clinical symptoms, pH-metry data, use of PPIs were recorded before the procedure and up to 18 months postoperatively. The FEV1 values before and after Nissen fundoplication were recorded at 3 monthly intervals. Patients' satisfaction scores were recorded before operation and postoperatively.
  
  
  RESULTS
  A total of 64 lung transplant patients were selected. After Nissen fundoplication, the pH studies were done on 26 patients. The mean overall acid exposure fraction was 1.03% (P<0.05). FEV1 declined for 6 months postoperatively and then gradually improved. The comparison of FEV1 at 3 months preoperatively to 3 months postoperatively showed no significant difference (P=0.067) as well as at 6 months. A significant improvement in clinical GERD symptoms was achieved after antireflux surgery; however, the patients remained receiving PPIs.
  
  
  CONCLUSIONS
  NF has been established as a safe operation for lung transplant patients. Late Nissen fundoplication did not improve lung function significantly amongst lung transplanted patients; however, patients with symptomatic GERD may have benefited from Nissen fundoplication in terms of symptom relief. A multicenter randomized control trial is needed to assess the effect of early unselected reflux control on respiratory function and graft survival.
authors.affiliation: Bristol Royal Infirmary, Bristol, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Pegna
authors.affiliation: Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: a_mickevicius@yahoo.com.
authors.forename: Antanas
authors.initials: A
authors.lastname: Mickevičius
authors.affiliation: St Vincent's Hospital, Sydney, Australia.
authors.forename: Clement
authors.initials: C
authors.lastname: Tsang
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012119:Respiration; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Gastroesophageal reflux disease; Lung transplant; Nissen fundoplication; Proton pump inhibitors; Reflux disease