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Increase in Size of Diaphragmatic Hiatus in Patients with GERD after Lung Transplantation.

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

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