PURPOSE: Patients with cystic fibrosis (CF) have progressive lung disease. GER in patients with CF can contribute to respiratory symptoms and nutritional failure. This study was done to evaluate efficacy of Nissen fundoplication and Gastrostomy tube in patients with CF and GERD and with worsening respiratory symptoms who fail medical therapy of GERD. Improvement, if any, was quantified by comparing changes in weight and BMI, lung function and pulmonary disease activity within two years before and after surgical management of GERD in children and adults with CF.
METHODS: We retrospectively reviewed charts of all patients with CF (n=495)and GERD followed at the CF Center at Nationwide Children’s Hospital, Columbus, OH, and, who underwent Nissen fundoplication over the last 20 years (1990-2010) (n=70). Patients who were followed for at least one year before and after their surgery were included in this study (n=48). We compared weight and BMI, number of hospital admissions, emergency room visits, pulmonary exacerbations and spirometry.
RESULTS: Median age at the time of surgery was 14 years (range 1-36), adult 19: children 29, male 23: female 25. Four patients had a Gastrostomy tube (G tube) prior to surgery and 29 patients received G tube at the time of surgery (n=33). Of them 28 patients received feeds through G tubes for more then 6 months and 26 of them were on G feeds at 2 years after surgery. Patients were divided into two groups based on if they had G tube and received G feeds for >6 months or not. In patients without >6 months of G feeds, compared to baseline, mean BMI dropped by -0.76 ± 1.9 at one year after Nissan (p<0.03). At the end of two years post surgery, patients without > 6 months of G feeds had mean drop in BMI (-1.3± 2) when compared to patients receiving > 6 months of G feeds who had mean increase in BMI (0.45 +/- 1.4) (p<0.004). At the end of 2 years post surgery, patients without > 6 months of G feeds had mean weight gain of 0.17 ± 3.4 kg while patients with > 6 months of G feeds had mean weight gain of 3.64 ± 5.1 kg (p<0.028). There was no significant difference in any pulmonary variables among these two groups.
CONCLUSIONS: In patients with CF and GERD receiving Nissen fundoplication, nutritional improvement is dependent on placement of G tube and G feeds for more then 6 months.
CLINICAL IMPLICATIONS: In patients with CF and severe GERD undergoing Nissen, G tube placement and G feeds are very significant for nutritional improvement after surgery.
DISCLOSURE: The following authors have nothing to disclose: Shahid Sheikh, Jackie Quach, Karen McCoy
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