Gastroesophageal reflux disease (GERD) has been linked with extraesophageal disorders, including interstitial lung disease (ILD). The nature of the GERD-ILD association and the role of fundoplication in the management of this disorder remain incompletely defined. Accordingly, our aim was to characterize our patients who underwent fundoplication with the intent of treating both GERD and associated ILD, as well as determining the impact of surgery on the course of their lung disease.
Retrospective chart review of patients who had GERD associated ILD and underwent fundoplication at Mayo Clinic, Rochester 1977-2002. Data abstracted included: age, sex, smoking status, clinical presentation, pharmacotherapies for GERD and ILD, pulmonary functions; chest roentgenogram and chest computed tomography (CT) findings; and bronchoscopic or surgical lung biopsy reports.
Fifteen patients (9 women) with GERD associated ILD underwent fundoplication at our center between 1997-2002. ILD was characterized clinico-radiologically as idiopathic pulmonary fibrosis/usual interstitial pneumonia (IPF/UIP) in 13 patients; 4 of these patients had surgical lung biopsies demonstrating 2 UIP and 2 organizing pneumonia. Age at time of ILD diagnosis was 66 ± 10 years (mean±SD); and age at the time of anti-reflux surgery was 68 ± 10 years (mean±SD). Fundoplication was performed laparoscopically in 11 patients. One perioperative death occurred. Post-operatively, anti-reflux pharmacotherapy was discontinued in all but 1 patient. Pre- and post-operative comparisons were possible in 5 patients with a median follow-up of 16 months (range: 5-33 months). Using the American Thoracic Society treatment assessment criteria (Am J Respir Crit Care Med 2000; 161:646-664), 2 patients remained stable and 3 worsened.CONCLUSIONS: Interstitial lung disease associated with GERD may have varying radiologic and histologic manifestations. Anti-reflux surgery does not uniformly result in clinical, radiologic, and physiologic improvement in patients with ILD-associated GERD.
The role of fundoplication surgery in the management of GERD associated ILD remains uncertain and needs to be explored further.
H.F. Nadrous, None.