PURPOSE: Patients with cystic fibrosis (CF) have progressive lung disease. GER is common and can contribute to respiratory symptoms. This study was done to evaluate efficacy of surgical management of GERD (Nissen fundoplication) in patients with CF and GERD with worsening respiratory symptoms who failed medical therapy of GERD.
METHODS: We retrospectively reviewed charts of all patients with CF (n=495) followed at the CF Center at Nationwide Children’s Hospital, Columbus, OH, and were able to find 70 patients with uncontrolled GERD who underwent Nissen fundoplication over the last 20 years (1990-2010). Patients who were followed for at least one year before and after their surgery were included in this study (n=48). We compared number of hospital admissions, emergency room visits, pulmonary clinic visits, pulmonary exacerbations, weight and spirometry.
RESULTS: Median age at the time of surgery was 14 years (range 1-36), adult 19: children 29, M:F 23:25. There was a significant decrease in CF exacerbations requiring intravenous antibiotics during the year after surgery (1.38±1.4) compared to one year before surgery (2.7±1.5). Mean FEV1 measured as % predicted, at the time of surgery (61±24.3) revealed significant deterioration when compared to FEV1 at one year before Nissen,(69±24.2). Mean FEV1 significantly improved at one year after surgery ( 66.4±23.6) but improvement was lost by the end of second year. Patients able to do PFT at the time of surgery (n=41) were divided into 2 groups based on their FEV1 either >60% (n=27, mean FEV1 80±12) or <60% (n=14, mean FEV1 39.4±10). Patients with baseline FEV1 <60% were 6 years older and stayed in hospital longer (12.7 vs. 8.6 days (p<0.04), had more hospital admissions/patient/year (6.67 vs. 3.22) (p<0.02) and had more courses of i/v antibiotics/patient/year (2.0 vs. 1.0) p<0.30). In patients with FEV1 >60%, there was no significant deterioration in mean FEV1 at 2 years after surgery but there was significant deterioration in mean FEV1 at 2 years in patients with FEV1 <60% at the time of surgery (p<0.005).
CONCLUSIONS: Surgical management of uncontrolled GERD in patients with CF slowed decline in lung function and need for i/v antibiotics for at least one year after surgery. Better outcome was noted within group with FEV1 >60% at the time of surgery.
CLINICAL IMPLICATIONS: In patients with CF and severe GERD, Nissen helps lung disease especially if done when FEV1 is > 60%.
DISCLOSURE: The following authors have nothing to disclose: Shahid Sheikh, Jackie Quach, Karen McCoy
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