Laparoscopic Nissen fundoplication for treating reflux in lung transplant recipients

O'Halloran, Elizabeth K.; Reynolds, James D.; Lau, Christine L.; Manson, Roberto J.; Davis, Robert D.; Palmer, Scott M.; Pappas, Theodore N.; Clary, Erik M.; Eubanks, William S.

doi:10.1016/j.gassur.2003.10.1013

Cited by 45 publications

(32 citation statements)

References 20 publications

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“…All LTx recipients had increased levels of pepsin in BALF, suggesting that aspiration after LTx might be a ubiquitous event, even in those patients with normal GOR indices. These data confirm earlier findings [9,22]. Bile acids have also been detected in BALF in 49% of LTx patients and none of the nontransplant samples, which was similar to the results reported by D'OVIDIO and coworkers [8,10].…”

Section: Discussionsupporting

confidence: 92%

Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection

Blondeau¹,

Mertens²,

et al. 2007

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Acid gastro-oesophageal reflux (GOR) and gastric aspiration have been labelled as risk factors for chronic rejection bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTx). The present study aimed to further characterise GOR (both acid and nonacid) and the degree of gastric aspiration in LTx recipients both with and without BOS.Impedance-pH recordings were used for GOR detection. Pepsin and bile acid levels were measured in bronchoalveolar lavage fluid (BALF).A total of 48% of patients had increased GOR, of which 27% had exclusively increased nonacid reflux. Cystic fibrosis patients had the highest prevalence of GOR. Pepsin was found in BALF of all patients and bile acids in BALF of 50% of the patients. Patients with BOS had neither increased GOR nor elevated pepsin in BALF. However, 70% of the patients with BOS had bile in BALF compared with 31% of stable patients. Proton pump inhibitor (PPI) treatment reduced acid reflux but did not affect nonacid reflux. Moreover, pepsin and bile levels in BALF were not reduced by PPI.One-half of the lung transplant patients had increased reflux, and nonacid reflux was common. Gastric aspiration occurred in most lung transplant patients. Pepsin was a more general marker and bile acids a more specific marker that might be associated with bronchiolitis obliterans syndrome. Proton pump inhibitor treatment did not prevent nonacid reflux and gastric aspiration.

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Section: Discussionsupporting

confidence: 92%

Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection

Blondeau¹,

Mertens²,

et al. 2007

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“…In the study of safety from Duke University, compared with the nontransplant population, there were no significant differences in operative time and blood loss [23]. Our study has comparable intra-operative data and no patients in our series have needed conversion to an open operation.…”

Section: Discussionmentioning

confidence: 61%

“…Our study has comparable intra-operative data and no patients in our series have needed conversion to an open operation. No intra-operative or perioperative deaths have been reported by the Duke University group [5,23,24], although, recently, one post-fundoplication death has been reported [25]. We have experienced no mortality to date and no major complications were encountered.…”

Section: Discussionmentioning

confidence: 69%

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

Robertson¹,

Krishnan²,

Ward³

et al. 2011

Eur Respir J

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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 (p50.01). Patients operated on for deteriorating lung function had a statistically significant decrease in the rate of lung function decline after fundoplication (p50.008).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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“…We define a trial of azithromycin as treating continuously with azithromycin for a minimum of Anti-reflux surgery Abnormal GOR (identified by oesophageal pH probe in the majority of studies) is highly prevalent in patients with advanced lung disease and in lung transplant recipients [65,66,68,[121][122][123][124][125][126], and it has been implicated as a risk factor for BOS [65,66,68,127,128]. For this reason, committee members routinely test patients with new onset BOS for GOR.…”

Section: Remarksmentioning

confidence: 99%

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

et al. 2014

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Bronchiolitis obliterans syndrome (BOS) is a major complication of lung transplantation that is associated with poor survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society convened a committee of international experts to describe and/or provide recommendations for 1) the definition of BOS, 2) the risk factors for developing BOS, 3) the diagnosis of BOS, and 4) the management and prevention of BOS.A pragmatic evidence synthesis was performed to identify all unique citations related to BOS published from 1980 through to March, 2013. The expert committee discussed the available research evidence upon which the updated definition of BOS, identified risk factors and recommendations are based. The committee followed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to develop specific clinical recommendations.The term BOS should be used to describe a delayed allograft dysfunction with persistent decline in forced expiratory volume in 1 s that is not caused by other known and potentially reversible causes of posttransplant loss of lung function. The committee formulated specific recommendations about the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and about re-transplantation in patients with suspected and confirmed BOS.The diagnosis of BOS requires the careful exclusion of other post-transplant complications that can cause delayed lung allograft dysfunction, and several risk factors have been identified that have a significant association with the onset of BOS. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Adequately designed and executed randomised controlled trials that properly measure and report all patient-important outcomes are needed to identify optimal therapies for established BOS and effective strategies for its prevention. Executive summaryMany lung transplant recipients develop delayed allograft dysfunction that has been traditionally referred to as bronchiolitis obliterans syndrome (BOS), which is thought to be caused by inflammation, destruction and fibrosis of small airways in the lung allograft that leads to obliterative bronchiolitis (OB). Because a definitive diagnosis of OB is difficult to make without a surgical lung biopsy, a decrease in the forced expiratory volume in 1 s (FEV1) has been used as a surrogate marker to identify patients who develop a syndrome of significant and persistent loss of lung allograft function with onset three or more months following transplantation. However, it is now recognised that numerous factors apart from OB can lead to a delayed onset, significant decline in lung function, and these causes of delayed onset graft dysfunction must be carefully excluded when a diagnosis of BOS is made. In general, BOS responds poorly to therapeutic interventions but may stabilise, and some patients may have a significant improvement in FEV1 with certain ther...

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Laparoscopic Nissen fundoplication for treating reflux in lung transplant recipients

Cited by 45 publications

References 20 publications

Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection

Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection

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

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

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