Anti-reflux surgery in lung transplant recipients: Outcomes and effects on quality of life

Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
European Respiratory Journal (Impact Factor: 7.64). 08/2011; 39(3):691-7. DOI: 10.1183/09031936.00061811
Source: PubMed


Fundoplication may improve survival after lung transplantation. Little is known about the effects of fundoplication on quality of life in these patients. The aim of this study was to assess the safety of fundoplication in lung transplant recipients and its effects on quality of life. Between June 1, 2008 and December 31, 2010, a prospective study of lung transplant recipients undergoing fundoplication was undertaken. Quality of life was assessed before and after surgery. Body mass index (BMI) and pulmonary function were followed up. 16 patients, mean ± sd age 38 ± 11.9 yrs, underwent laparoscopic Nissen fundoplication. There was no peri-operative mortality or major complications. Mean ± SD hospital stay was 2.6 ± 0.9 days. 15 out of 16 patients were satisfied with the results of surgery post fundoplication. There was a significant improvement in reflux symptom index and DeMeester questionnaires and gastrointestinal quality of life index scores at 6 months. Mean BMI decreased significantly after fundoplication (p = 0.01). Patients operated on for deteriorating lung function had a statistically significant decrease in the rate of lung function decline after fundoplication (p = 0.008). Laparoscopic fundoplication is safe in selected lung transplant recipients. Patient benefit is suggested by improved symptoms and satisfaction. This procedure is acceptable, improves quality of life and may reduce deterioration of lung function.

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Available from: Andrew G Robertson, May 20, 2014
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    • "Yet, the effects are unknown on modifying risk factors and acid inhibit therapy in bronchiectasis patients. LF has been performed for GER in end-stage lung diseases mainly including idiopathic pulmonary fibrosis, cystic fibrosis and COPD before or after lung transplantation, and is beneficial for lung functions, allograft and quality of life in the selected patients [32-35]. A report by Davis et al. showed that within a group of patents with lung transplantations, fundoplication in two patients with advanced bronchiectasis had resulted in lung function improvements and reduction in oxygen requirements [36]. "
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    ABSTRACT: Background Bronchiectasis is a progressive and fatal disease despite the available treatment regimens. Gastroesophageal reflux (GER) may play an important role in the progression of bronchiectasis. However, active anti-reflux intervention such as Stretta radiofrequency (SRF) and/or laparoscopic fundoplication (LF) have rarely been used to treat Bronchiectasis. Case Presentation Seven patients’ clinical outcomes for treating GER-related deteriorated bronchiectasis were retrospective reviewed. All patients were treated by SRF and/or LF, and had follow-up periods ranging from one to five years. Typical GER symptoms, respiratory symptoms, medication consumption and general health status were assessed during the follow-ups. At the latest follow-up all patients were alive. The typical GER symptoms disappeared in five people and were significantly improved in the other two. Two had complete remissions of both respiratory symptoms and bronchiectasis exacerbations; four had significantly improved respiratory symptoms to mild/moderate degrees as well as reduced or zero bronchiectasis exacerbations, which allowed them to resume the physical and social functions; one’s respiratory symptoms and bronchiectasis exacerbations were not much improved, yet she was in stable condition and satisfied with the results. Conclusions Potentially, GER plays an important role in some patients with bronchiectasis, and active anti-reflux treatments can be beneficial. Future clinical studies are suggested to clarify GER’s role in bronchiectasis and to further determine whether anti-reflux interventions for GER can improve the outcomes of patients with bronchiectasis.
    Full-text · Article · Jun 2013 · BMC Pulmonary Medicine

  • No preview · Article · Dec 2012 · European Respiratory Review
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    ABSTRACT: BACKGROUND: The aim of this study was to determine the safety of anti-reflux surgery for lung transplant recipients and assess its effect on lung function. METHODS: We retrospectively collected and analyzed data from all lung transplant recipients who underwent anti-reflux surgery at St Mary's Hospital London from July 2005 to May 2012. The indications for surgery were histologic evidence of gastroesophageal reflux aspiration on bronchoscopy biopsy specimens or a positive impedance study with symptomatic reflux or a consistent decline/fluctuating forced expiratory volume in 1 second (FEV1). We studied the difference in mean FEV1 and rate of change of FEV1, before and after fundoplication. The safety of anti-reflux surgery was determined by post-operative morbidity and mortality and compared with predicted figures, using a risk prediction model based on the P-POSSUM (Portsmouth Modification of the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) assessment. RESULTS: Forty patients underwent laparoscopic Nissen fundoplication. Overall, mean FEV1 declined from 2119 ± 890 to 1967 ± 1027ml (p = 0.027), and mean rate of change in FEV1 improved from -2.42 ± 4.40 to -0.41 ± 1.77ml/day (p = 0.007). Patients referred for fundoplication based on histologic evidence of reflux (n = 9) showed an improvement in rate of change of FEV1 from -3.39 ± 6.00 to -0.17 ± 1.50ml/day (p = 0.057), and those with positive impedance study and consistent decline in FEV1 (n = 13) showed a significant improvement from -3.62 ± 3.35 to -0.74 ± 2.33ml (p = 0.021). Actual and predicted morbidity was 2.5% and 31%, respectively. Actual and predicted 30-day mortality was 0% and 1.9%, respectively. CONCLUSIONS: Anti-reflux surgery is safe for lung transplant recipients and results in an improvement in the rate of change in FEV1 despite a decline in mean FEV1 post-operatively.
    Full-text · Article · Mar 2013 · The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation
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