PURPOSE: Symptomatic or silent Gastro Esophageal Reflux Diseases (GERD) is a significant problem in adult Cystic Fibrosis (CF) patients. GERD contributes to bronchial hyperresposiveness in asthmatics, which in small studies has shown to be reversed by Laparoscopic Nissen Fundoplication (LNF). LNF has been implicated to cause significant weight loss in non-CF patients. Weight loss indicates a poor prognosis in CF patients. The safety of LNF and its effect on the disease progression in adult CF is not known.
METHODS: The charts of adult CF patients who underwent LNF were reviewed. Patients were assessed subjectively (severe GERD symptoms not responsive to adequate medical management) and objectively (esophagogastroduodenoscopy, pH probe and esophageal manometry) prior to surgery. Trends of spirometry, weights, rate of pulmonary exacerbations, prednisone usage and GERD symptoms were analyzed for the year before and the year after surgery.
RESULTS: 8/83 adult CF patients underwent LNF between April 1999 to June 2004. The mean DeMeester’s score was 30.3+/−8.56 (+/− SD) [normal<14.72 (95th percentile)]. The procedure was well tolerated with post-operative complication in 1 patient (accidental injury to gastric artery requiring transfusion). Postoperative subjective GERD symptoms improvement was noted in all patients. Surgical failure occurred in 2 patients after 3 years of initial surgery, necessitating a redo LNF, which was successful in both patients. A statistically significant decrease in weight [66.18 +/− 9.2 kg to 61.0 +/− 6 kg; p<0.02)] occurred post surgery. The patients did not regain the lost weight during the follow up period. The mean FEV1 % predicted, the exacerbation rates and prednisone usage per year, demonstrated a decreasing trend but did not reach statistical significance.
CONCLUSION: LNF is well tolerated by CF patients and leads to subjective symptomatic improvement. Weight loss from LNF may be detrimental in these patients as it signifies poor prognosis. Decline in FEV1, prednisone usage and pulmonary exacerbations post surgery, did not reach statistical significance.
CLINICAL IMPLICATIONS: LNF in adult CF is associated with a significant weight loss.
DISCLOSURE: Arvind Perathur, None.