American Surgical Association
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Prevalence of Gastroesophageal Reflux Disease in Patients Awaiting Lung Transplantation
Matthew Sweet, MD*, Lorriana Leard, MD*, Fernando AM Herbella, MD*, Jeffrey Golden, MD*, Steven Hays, MD*, Charles Hoopes, MD*, Marco Patti, MD
University of California San Francisco, San Francisco, CA

Objective: Patients undergoing lung transplantation in the presence of gastroesophageal reflux disease (GERD) have accelerated graft failure. No previous studies have properly measured proximal reflux, which may be a more sensitive marker of micro-aspiration. The objective of this study was to determine the prevalence and proximal extent of GERD in patients awaiting lung transplantation.
109 patients with end stage lung disease underwent esophageal manometry and esophageal pH monitoring, using 2 sensors at 5 and 20 cm above the LES. Proximal reflux was defined by a pH 1.3% of the study time.
Prevalence of Distal and Proximal Reflux by Lung Disease Subgroups
Number of PatientsGERD (%)Proximal Reflux (%)
All Patients10974 (68)37 (35)
Type of Lung Disease
Restrictive6245 (73)19 (31)
Obstructive3521 (60)13 (38)
Mixed43 (75)2 (50)
Pulmonary Hypertension74 (57)2 (33)
Other11 (100)1 (100)

Fifty per cent of patients with GERD had no typical reflux symptoms.
Conclusions. These data show that: (a) 68% of patients awaiting lung transplant have GERD and symptoms are not a reliable means of diagnosis; (b) in 50% of those with GERD acid refluxes all the way to the proximal esophagus. These data suggest the need for aggressive screening for GERD in this population, and raise the question of treating these patients with a fundoplication to avoid damage to the transplanted lung.

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