Fundoplication Reduces Risk of Lung Transplant Rejection in GERD Patients

Sheetal Patel, MD

Laparoscopic Toupet fundoplication (LTF) could be a useful took in reducing the risk of lung transplant rejection in patients with gastroesophageal reflux disease (GERD).

A team, led by Sheetal Patel, MD, University of Florida, evaluated the efficacy of laparoscopic Toupet fundoplication in lung transplant recipients with GERD.

The data was presented as a late-breaking abstract at the 2022 American College of Gastroenterology (ACG) Annual Meeting in Charlotte.

The Risk of Lung Transplant Rejection

While GERD with microaspiration is a modifiable risk factor for lung transplant rejection, fundoplication could prevent rejection in this patient population. In addition, Nissen is linked to higher rates of postoperative dysphagia.

In the retrospective case series, the investigators examined 56 lung transplant recipients who underwent LTF between September 2018 and November 2020. There was a median follow-up of 31.4 months. The investigators collected pre- and post-operative results from 24 hour pH study, 4 hour gastric emptying study, and high resolution esophageal manometry, distal contractile integral, and lower esophageal sphincter pressure.

They also reviewed charts for symptom severity.

Finally, they assessed lung function using forced expiratory volume in 1 second.

The Benefit of Fundoplication

Following fundoplication, the median DeMeester score decreased from 32-3.7 (P <0.0001). In addition, the percentage of total time with pH less than 4 decreased from 7.4-0.5% (P <0.0001).

The overall severity of heartburn and regurgitation also reduced (P <0.0001 and P = 0.0002, respectively).

The investigators also did not identify a difference between pre-and-post-LTF IRP, DCI, and LESP [medians of 10.3 vs 9.1 mmHg, 1896 vs 1931 mmHg.s.cm, 24.05 vs 25.6 mmHg and P = 0.2, P = 0.8, P = 0.5 respectively].

Following fundoplication, the median gastric retention at 4 hours normalized from 13-4%.

However, this different was not statistically significant (P = 0.4), while symptom severity of bloating, distension. Nausea, and dysphagia were also not significantly different pre- and post-LTF.

Finally, there was no significant differences in FEV1 at week 6, month 3, month 6, month 12, and beyond one-year following LTF compared to baseline.

“In this study, we demonstrate that LTF provides objective acid reflux control while preserving lung function and foregut motility in [lung transplant] recipients without significant postoperative symptoms,” the authors wrote. “In the largest series of LTF in [lung transplant] recipients to date, we show that it has the potential to become the anti-reflux procedure of choice in this high-risk population.”

The study, “53 - Laparoscopic Toupet Fundoplication Normalizes Esophageal Acid Exposure While Preserving Foregut Motility and Lung Function in Lung Transplant Recipients (Late-Breaking Abstract),” was published online by ACG.