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Eur J Pediatr Surg
DOI: 10.1055/s-0044-1791801
Original Article

The Role of GERD Diagnosis and Treatment in Preventing Lung Function Decline After Pediatric Lung Transplantation

Elena Chiara Garrisi
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Carsten Müller
2   Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
,
Benno Ure
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Julia Carlens
2   Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
,
Jens Dingemann 
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Nagoud Schukfeh
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
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Abstract

Background/Purpose Gastroesophageal reflux disease (GERD) after lung transplantation (LuTx) can lead to chronic lung allograft dysfunction. Our aim was to assess the prevalence of GERD in pediatric LuTx recipients and to investigate the impact of medical and surgical GERD treatment on lung function.

Methods Ethical approval was obtained. Data of all consecutive patients who underwent LuTx from 2013 to 2023 and aged < 18 years at the time of the study were prospectively collected. A GERD diagnostic algorithm was established, including assessment of symptoms (vomiting, heartburn, regurgitation, cough, recurrent airway infections), bronchoscopy, forced expiratory volume in 1 second, and pH impedance. Further investigations included upper gastrointestinal series and esophagogastroduodenoscopy. Patients with GERD underwent medical treatment or fundoplication. Lung function was monitored.

Results Thirty-six patients (2 months–18 years, 50% male) were included. Twenty-nine (80%) underwent spirometry, 16 (45%) pH impedance study, and 14 (39%) esophagogastroduodenoscopy. Twenty-two (61%) had no GERD symptoms and 12 (33%) showed normal pH impedance study or esophagogastroduodenoscopy. Fourteen (39%) patients had GERD symptoms, all 9 tested symptomatic patients (25%) had pathological GERD-specific diagnostics. Three (8%) patients underwent fundoplication after a median of 1.6 years (range 1.1–5.7 years) post-LuTx without surgical complications. After a median follow-up of 2.3 years (range 1.3–2.8 years) post-fundoplication, all (n = 3) had complete remission of GERD symptoms and lung function improvement. Lung function decline was observed in 6 (67%) of the tested symptomatic patients on proton-pump inhibitors (PPIs) treatment.

Conclusion Over one-third of our patients presented with GERD symptoms after LuTx. Symptoms and lung function may be reliable GERD indicators. Given the high prevalence of GERD, we suggest a routine posttransplant diagnostic algorithm including pH impedance study. Eighty percent of all symptomatic patients had a lung function decline despite PPI. Fundoplication is safe and may improve long-term outcome in pediatric LuTx recipients.

Keywords

fundoplication - bronchiolitis obliterans syndrome (BOS) - proton-pump inhibitors (PPI) - forced expiratory volume in 1 second (FEV1) - pH impedance study


Publication History

Received: 08 May 2024

Accepted: 23 September 2024

Article published online:
17 October 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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