Little is known about the etiology of Tracheobronchomalacia (TBM) and exacerbating factors. Gastroesophageal reflux disease (GERD) has been associated with respiratory disorders and a higher prevalence of GERD has been noted in infants with TBM; such data is lacking in adults. This retrospective review was performed to determine the prevalence of GERD in an adult TBM population and its impact on outcomes of tracheoplasty.
Retrospective review of prospectively acquired data from an institutional tracheomalacia patient registry. GERD evaluation is a routine recommendation for our patients. All patients undergoing formal testing by pH probe, impedance, or upper endoscopy were reviewed.
From August 2005 to April 2009, 34 (21 female) adult TBM patients underwent testing for GERD. 18 of 34 patients were GERD (+) yielding a prevalence of 53% in this unselected TBM population (prevalence in the western world 20%, p < 0.001). The mean DeMeester score of GERD (+) patients was 39.6 (range 17–99.2). There was no reflux symptom correlation in more than 50% of patients. Thirteen of the 34 patients underwent tracheoplasty for treatment. Eight of 13 were GERD (+); 3 of the 8 (38%) had an unsuccessful tracheoplasty; 2 of these 3 had DeMeester scores > 50 and required fundoplication. Only 1 of 5 (20%) GERD (-) tracheoplasty patients had an unsuccessful repair.
GERD seems more prevalent in the TBM population compared with the general population. It may be silent and may negatively impact the outcome of surgical tracheoplasty.
The role of GERD in patients with TBM deserves further study. In the meantime the presence of GERD in TBM should be tested for and if present, we recommend aggressive treatment.
Dilip Nataraj, No Financial Disclosure Information; No Product/Research Disclosure Information