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Lung transplant recipients benefit from GERD surgery.

NEW YORK -- Surgeons at Columbia University in New York are performing laparoscopic Nissen fundoplication in many lung transplant recipients who show evidence of significant gastroesophageal reflux and chronic rejection, Dr. Joshua R. Sonett said at a conference on pulmonary and critical care medicine sponsored by Columbia University.

The theory behind the surgery is that gastroesophageal reflux disease contributes to lung injury and the development of bronchiolitis obliterans syndrome (BOS), an Achilles heel for long-term survival of lung transplant patients. Hence, preventing GERD will improve lung function and prevent chronic rejection after transplant, said Dr. Sonett, surgical director of the Columbia University lung transplant program.

In a study published in 2003, researchers from Duke University, Durham, N.C., found that performing fundoplication in lung transplant recipients with GERD improved lung function (J. Thorac. Cardiovasc. Surg. 2003;125:533-42). In that study, researchers used an esophageal pH probe to assess reflux, and found abnormal pH values in 93 of 128 patients (73%) who had undergone a lung transplant. Patients who underwent fundoplication had improved bronchiolitis obliterans syndrome scores, and some no longer met the criteria for BOS. Researchers at the University of Toronto obtained similar results, Dr. Sonett said.

The improvement in scores in those who received fundoplication is key, because for most lung transplant recipients who begin to have bronchiolitis obliterans syndrome, there is no turning back, he said.

In addition to contributing to BOS, reflux disease causes bronchospasm and aspiration, and exacerbates asthma, he added.

Thus far, there have been virtually no effective therapies to stop chronic rejection, he said.

"We now know that chronic reflux can lead to chronic rejection in the lung," Dr. Sonett said. "It's not the whole story, but there's certainly a population of patients post transplant who have reflux that go on to chronic rejection, and if you stop that reflux, they will stop having chronic rejection."

Researchers also have begun to consider the role that reflux disease plays in patients with interstitial lung disease and other lung diseases preoperatively. Clearly, physicians should not perform reflux procedures in patients just because they have GERD and interstitial lung disease, he said, but researchers need to continue to look at what subset of patients could benefit from antireflux procedures.
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Title Annotation:News; laparoscopic Nissen fundoplication; gastroesophageal reflux
Author:Schneider, Mary Ellen
Publication:Internal Medicine News
Geographic Code:1U2NY
Date:Feb 1, 2006
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