If you are a lung transplant patient there are good chances you may eventually need an anti-reflux surgery. The name of that surgery is Nissen Fundoplication. For some lung transplant recipients this could be a lifesaving surgery in the long run because the purpose of it is to save the lung function. The University Of Pittsburgh School Of Medicine reports that out of 43 of their patients who have undergone this anti-reflux surgery, nearly all of them improved their lung function. Not only this surgery helps post-lung transplant but can also benefit patients waiting for a new organ.
According to Blair Jobe, M.D., professor of surgery, Department of Cardiothoracic Surgery, Pitt School of Medicine, many end-stage lung disease patients, especially cystic fibrosis and pulmonary fibrosis patients, have what they call gastro-esophageal reflux disease (GERD). Almost half of those patients do not experience any typical heartburn symptom but still, the gastric juice coming up the esophagus and going in the lungs is damaging. It has also been recognized as causing acute lung rejection and ultimately leading to chronic rejection. Chronic rejection, medically known as Bronchiolitis Obliterans, is when the lung function slowly goes down with little chance for recovery. Patients can live many years once a diagnosis of chronic rejection has been established but with a lower quality of life. Gastric reflux is a medical problem that really needs to be addressed seriously by transplant pulmonologists.
No Heartburn? How is Gastric Reflux Diagnosed then?
Usually what happens is a patient will have an unexplained drop in lung function. A bronchoscopy will be done to rule any acute rejection, infection or narrowing of the airway. Narrowing of the airway is called bronchial stenosis. Once all of that is negative, gastric reflux is highly suspected and a 24 hours Ph probe study is ordered. This test consists of a small probe inserted into the nose going to the stomach. It stays there for 24 hours and it is attached to a small reader that the patient carries in a bag. To be noted that it is an outpatient testing and patients do go home with the probe.
Once the 24 hours has passed, a physician will interpret the data. The probe actually records the number of reflux episodes and monitors the Ph (acidity). It also records some pressure in the stomach. Sometimes you can have patients with 60 plus episodes of reflux non-acidic which means they can’t feel it since it won’t burn. With or without burning sensation, if there are many reflux episodes, the patient is referred to a general surgeon for a Nissen Fundoplication.
What Is a Fundoplication?
It is usually done laparoscopically, which means by using a small camera through small holes in the skin. The surgeon will wrap the gastric fundus (top part of the stomach) around the esophagus in order to reinforce the esophageal sphincter. The goal is to prevent the gastric content from going up the esophagus and into the lungs preserving the lungs for lung transplant patients. The surgery is done under anesthesia by a general surgeon and requires 4-5 days in the hospital for recovery. The main complication reported is a problem of bloating. It may be hard for patients to belch after that surgery so gas may accumulate in the stomach. After 10 years, 90% of the patients are symptoms free though.
I can say, with my own personal experience without any scientific evidence, that lung transplants patients that had that surgery done were doing better after with improved lung function. The challenge sometimes is to explain the patients why they need the surgery when they are symptoms free.