Mark A Boccola, Douglas Fenton-Lee. St Vincent’s Hospital Sydney
INTRODUCTION: GERD is a risk factor for chronic rejection of the transplanted lung. This progressive destruction takes the clinical form of bronchiolitis obliterans syndrome which anti-reflux surgery can stabilize. The literature has focused on damage to the vagal nerve causing gastroparesis and distal esophageal dysmotility as the cause of GERD. Hiatal dilatation as the main cause for GERD in lung transplant patients has not been previously reported. The aim of this study was to assess whether hiatal dilatation post-transplant surgery occurs and whether it is associated with the development of GERD.
METHODS: A case control study was performed on patients that had undergone lung transplant between 2009- 2014. Patients who developed post-transplant GERD demonstrated on pH studies were matched to controls with negative pH studies or no evidence of rejection on bronchoscopy. Patients that underwent MDCT Chest before and after lung transplant were included, patients with GERD pre-transplant were excluded. Post scan processing was performed to obtain the double-oblique plane of the hiatus and region of interest function used to determine Hiatal Surface Area (HSA) according to the protocol described by Ouyang et al. Statistical analysis was performed using two-tailed Mann-Whitney U test, results expressed using mean values.
RESULTS:
| n=30 | GERD (15) | Control (15) | p-value |
| Age (years) | 55 | 53 | 0.61708 |
| BMI (kg/m2) | 24.8 | 23.96 | 0.88076 |
| Length of operation (hours) | 6.55 | 6.38 | 0.74896 |
| Length of ICU stay (days) | 8.87 | 10.13 | 0.14706 |
| Length of hospital stay (days) | 22.47 | 21.53 | 0.86502 |
| FEV1 post-transplant (L) | 2.27 | 2.11 | 0.72634 |
| pH study- Overall reflux % | 10.74 | 2.07 | 0.00084 |
| pH study- Nocturnal reflux % | 15.15 | 4.2 | 0.00288 |
| HSA | |||
| Pre-transplant (cm2) | 3.83 | 4.08 | 0.5485 |
| Post-transplant (cm2) | 6.86 | 4.34 | 0.00244 |
CONCLUSION: We demonstrate that HSA increased in lung transplant patients with GERD while there was no significant change for patients who did not have reflux. This has important implications and larger prospective studies will enable early identification of patients at risk.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79860
Program Number: S087
Presentation Session: SAGES Got Talent : Resident & Fellow Scientific Session
Presentation Type: ResFel