title: LINX®, a novel treatment for patients with refractory asthma complicated by gastroesophageal reflux disease: a case report.
abstract: BACKGROUND
  Gastroesophageal reflux disease is one of the most common comorbidities in patients with asthma. Gastroesophageal reflux disease can be linked to difficult-to-control asthma. Current management includes gastric acid suppression therapy and surgical antireflux procedures. The LINX® procedure is a novel surgical treatment for patients with gastroesophageal reflux disease refractory to medical therapy. To the best of our knowledge, we report the first case of successful treatment of refractory asthma secondary to gastroesophageal reflux disease using the LINX® procedure.
  
  
  METHODS
  Our patient was a 22-year-old white woman who met the American Thoracic Society criteria for refractory asthma that had remained poorly controlled for 5 years despite progressive escalation to step 6 treatment as recommended by National Institutes of Health-National Asthma Education and Prevention Program guidelines, including high-dose oral corticosteroids, high-dose inhaled corticosteroid plus long-acting β2-agonist, leukotriene receptor antagonist, and monthly omalizumab. Separate trials with azithromycin therapy and roflumilast did not improve her asthma control, nor did bronchial thermoplasty help. Additional consultations with two other university health systems left the patient with few treatment options for asthma, which included cyclophosphamide. Instead, the patient underwent a LINX® procedure after failure of maximal medical therapy for gastroesophageal reflux disease with the additional aim of improving asthma control. After she underwent LINX® treatment, her asthma improved dramatically and was no longer refractory. She had normal exhaled nitric oxide levels and loss of peripheral eosinophilia after LINX® treatment. Prednisone was discontinued without loss of asthma control. The only immediate adverse effects due to the LINX® procedure were bloating, nausea, and vomiting.
  
  
  CONCLUSIONS
  LINX® is a viable alternative to the Nissen fundoplication procedure for the treatment of patients with gastroesophageal reflux disease and poorly controlled concomitant refractory asthma.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA. dr.narin.s@gmail.com.|VA Northern California Health Care System, Mather, CA, USA. dr.narin.s@gmail.com.|Department of Internal Medicine, The Queen's Medical Center, 1301 Punchbowl St, Honolulu, HI, 96813, USA. dr.narin.s@gmail.com.
authors.forename: Narin
authors.initials: N
authors.lastname: Sriratanaviriyakul
authors.affiliation: Department of Respiratory Care, University of California, Davis, 4150 V Street, Suite 3100, Sacramento, CA, 95817, USA.
authors.forename: Celeste
authors.initials: C
authors.lastname: Kivler
authors.affiliation: Department of Surgery, University of California, Davis, 4150 V Street, Suite 3100, Sacramento, CA, 95817, USA.
authors.forename: Tamas J
authors.initials: TJ
authors.lastname: Vidovszky
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.|VA Northern California Health Care System, Mather, CA, USA.
authors.forename: Ken Y
authors.initials: KY
authors.lastname: Yoneda
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.|VA Northern California Health Care System, Mather, CA, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Kenyon
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.|VA Northern California Health Care System, Mather, CA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Murin
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.|VA Northern California Health Care System, Mather, CA, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Louie
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents
keywords: Asthma; Fundoplication; GERD; LINX; Reflux