Advertisement

Gastroesophageal Reflux and Esophageal Dysmotility in Patients Undergoing Evaluation for Lung Transplantation: Assessment, Evaluation, and Management

  • Robert B. Yates
  • Carlos A. Pellegrini
  • Brant K. Oelschlager
Chapter

Abstract

Gastroesophageal reflux disease (GERD) can dramatically affect quality of life but rarely results in significant complications. Moreover, since GERD can be effectively managed with proton pump inhibitor therapy, the disease is mostly thought of as a very benign condition—easy to diagnose and easy to treat. However, over the past 20 years, a darker side of GERD has emerged: GERD has become implicated in the development of several chronic progressive pulmonary diseases. Esophageal dysmotility is a common comorbid condition in patients with GERD, and this association is even stronger in patients with GERD and chronic lung disease. Importantly, when lung transplantation is considered as definitive therapy for end-stage lung disease, it is even more important to identify and treat GERD and esophageal dysmotility, because GERD is closely associated with the development of bronchiolitis obliterans syndrome, graft dysfunction, and even death. A thorough evaluation of any patient suspected to have GERD should include esophageal manometry and pH testing, an esophagram, and an upper gastrointestinal endoscopy. In any patient with confirmed GERD and life-limiting symptoms that are incompletely managed with medications, antireflux surgery should be considered. In patients with GERD and end-stage lung disease (before or after transplantation), antireflux surgery may mitigate the deleterious effects of GERD on lung function. Importantly, due to their multiple unique and complex medical needs, any patient with GERD and end-stage lung disease or a history of lung transplantation should be managed at a quaternary care center by a multidisciplinary team that includes an experienced gastroesophageal surgeon.

Keywords

Gastroesophageal reflux disease Esophageal dysmotility Antireflux surgery Chronic lung disease Laryngopharyngeal reflux Extraesophageal reflux Lung transplantation 

Abbreviations

BOS

Bronchiolitis obliterans

CTD

Connective tissue disease

DGE

Delayed gastric emptying

FEV1

Forced expiratory volume in 1 s

GEJ

Gastroesophageal junction

GER

Gastroesophageal reflux

GERD

Gastroesophageal reflux disease

HRM

High-resolution esophageal manometry

IEM

Ineffective esophageal motility

IPF

Idiopathic pulmonary fibrosis

LES

Lower esophageal sphincter

PPI

Proton pump inhibitor

References

  1. 1.
    Galmiche JP, Janssens J. The pathophysiology of gastro-oesophageal reflux disease: an overview. Scand J Gastroenterol Suppl. 1995;211:7–18.CrossRefPubMedGoogle Scholar
  2. 2.
    Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–74.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Diener U, Patti MG, Molena D, Fisichella PM, Way LW. Esophageal dysmotility and gastroesophageal reflux disease. J Gastrointest Surg. 2001;5(3):260–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Quigley EMM. Gastro-oesophageal reflux disease—spectrum or continuum? QJM. 1997;90(1):75–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Ho KY, Kang JY. Reflux esophagitis patients in Singapore have motor and acid exposure abnormalities similar to patients in the Western hemisphere. Am J Gastroenterol. 1999;94(5):1186–91.CrossRefPubMedGoogle Scholar
  6. 6.
    Heider TR, Behrns KE, Koruda MJ, Shaheen NJ, Lucktong TA, Bradshaw B, et al. Fundoplication improves disordered esophageal motility. J Gastrointest Surg. 2003;7(2):159–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Pellegrini CA, DeMeester TR, Johnson LF, Skinner DB. Gastroesophageal reflux and pulmonary aspiration: incidence, functional abnormality, and results of surgical therapy. Surgery. 1979;86(1):110–9.PubMedGoogle Scholar
  8. 8.
    Fouad YM, Katz PO, Hatlebakk JG, Castell DO. Ineffective esophageal motility: the most common motility abnormality in patients with GERD-associated respiratory symptoms. Am J Gastroenterol. 1999;94(6):1464–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Basseri B, Conklin JL, Pimentel M, Tabrizi R, Phillips EH, Simsir SA, et al. Esophageal motor dysfunction and gastroesophageal reflux are prevalent in lung transplant candidates. Ann Thorac Surg. 2010;90(5):1630–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Suen HC, Hendrix H, Patterson GA. Special article: physiologic consequences of pneumonectomy. Consequences on the esophageal function. 1999. Chest Surg Clin N Am. 2002;12(3):587–95.CrossRefPubMedGoogle Scholar
  11. 11.
    Davis CS, Shankaran V, Kovacs EJ, Gagermeier J, Dilling D, Alex CG, et al. Gastroesophageal reflux disease after lung transplantation: pathophysiology and implications for treatment. Surgery. 2010;148(4):737–45.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Fisichella PM, Jalilvand A. The role of impaired esophageal and gastric motility in end-stage lung diseases and after lung transplantation. J Surg Res. 2014;186(1):201–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Berkowitz N, Schulman LL, McGregor C, Markowitz D. Gastroparesis after lung transplantation: potential role in postoperative respiratory complications. Chest. 1995;108(6):1602–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Davis CS, Jellish WS, Fisichella PM. Laparoscopic fundoplication with or without pyloroplasty in patients with gastroesophageal reflux disease after lung transplantation: how I do it. J Gastrointest Surg. 2010;14(9):1434–41.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Moore JM, Vaezi MF. Extraesophageal manifestations of gastroesophageal reflux disease: real or imagined? Curr Opin Gastroenterol. 2010;26(4):389–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Chang AB, Lasserson TJ, Kiljander TO, Connor FL, Gaffney JT, Garske LA. Systematic review and meta-analysis of randomised controlled trials of gastro-oesophageal reflux interventions for chronic cough associated with gastro-oesophageal reflux. BMJ. 2006;332(7532):11–7.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Vaezi MF, Richter JE. Twenty-four-hour ambulatory esophageal pH monitoring in the diagnosis of acid reflux-related chronic cough. South Med J. 1997;90(3):305–11.CrossRefPubMedGoogle Scholar
  18. 18.
    Waring JP, Lacayo L, Hunter J, Katz E, Suwak B. Chronic cough and hoarseness in patients with severe gastroesophageal reflux disease. Diagnosis and response to therapy. Dig Dis Sci. 1995;40(5):1093–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D, et al. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut. 2006;55(10):1398–402.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Vela MF. Non-acid reflux: detection by multichannel intraluminal impedance and pH, clinical significance and management. Am J Gastroenterol. 2009;104(2):277–80.CrossRefPubMedGoogle Scholar
  21. 21.
    Wassenaar E, Johnston N, Merati A, Montenovo M, Petersen R, Tatum R, et al. Pepsin detection in patients with laryngopharyngeal reflux before and after fundoplication. Surg Endosc. 2011;25(12):3870–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Worrell SG, DeMeester SR, Greene CL, Oh DS, Hagen JA. Pharyngeal pH monitoring better predicts a successful outcome for extraesophageal reflux symptoms after antireflux surgery. Surg Endosc. 2013;27(11):4113–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Ducoloné A, Vandevenne A, Jouin H, Grob JC, Coumaros D, Meyer C, et al. Gastroesophageal reflux in patients with asthma and chronic bronchitis. Am Rev Respir Dis. 1987;135(2):327–32.PubMedGoogle Scholar
  24. 24.
    Davis MV. Relationship between pulmonary disease, hiatal hernia, and gastroesophageal reflux. N Y State J Med. 1972;72(8):935–8.PubMedGoogle Scholar
  25. 25.
    Bowrey DJ, Peters JH, DeMeester TR. Gastroesophageal reflux disease in asthma: effects of medical and surgical antireflux therapy on asthma control. Ann Surg. 2000;231(2):161–72.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Bandeira CD, Rubin AS, Cardoso PFG, Moreira J da S, Machado M da M. Prevalence of gastroesophageal reflux disease in patients with idiopathic pulmonary fibrosis. J Bras Pneumol. 2009;35(12):1182–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Raghu G, Freudenberger TD, Yang S, Curtis JR, Spada C, Hayes J, et al. High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis. Eur Respir J. 2006;27(1):136–42.CrossRefPubMedGoogle Scholar
  28. 28.
    Salvioli B, Belmonte G, Stanghellini V, Baldi E, Fasano L, Pacilli AMG, et al. Gastro-oesophageal reflux and interstitial lung disease. Dig Liver Dis. 2006;38(12):879–84.CrossRefPubMedGoogle Scholar
  29. 29.
    Tobin RW, Pope CE, Pellegrini CA, Emond MJ, Sillery J, Raghu G. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1998;158(6):1804–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Allaix ME, Fisichella PM, Noth I, Herbella FA, Borraez Segura B, Patti MG. Idiopathic pulmonary fibrosis and gastroesophageal reflux. Implications for treatment. J Gastrointest Surg. 2014;18(1):100–4–5.Google Scholar
  31. 31.
    Fahim A, Crooks M, Hart SP. Gastroesophageal reflux and idiopathic pulmonary fibrosis: a review. Pulm Med. 2010;2011:e634613.Google Scholar
  32. 32.
    Sweet MP, Patti MG, Leard LE, Golden JA, Hays SR, Hoopes C, et al. Gastroesophageal reflux in patients with idiopathic pulmonary fibrosis referred for lung transplantation. J Thorac Cardiovasc Surg. 2007;133(4):1078–84.CrossRefPubMedGoogle Scholar
  33. 33.
    Hershcovici T, Jha LK, Johnson T, Gerson L, Stave C, Malo J, et al. Systematic review: the relationship between interstitial lung diseases and gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2011;34(11–12):1295–305.CrossRefPubMedGoogle Scholar
  34. 34.
    Lee JS, Ryu JH, Elicker BM, Lydell CP, Jones KD, Wolters PJ, et al. Gastroesophageal reflux therapy is associated with longer survival in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2011;184(12):1390–4.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Kilduff CE, Counter MJ, Thomas GA, Harrison NK, Hope-Gill BD. Effect of acid suppression therapy on gastroesophageal reflux and cough in idiopathic pulmonary fibrosis: an intervention study. Cough. 2014;10:4.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Raghu G, Yang ST-Y, Spada C, Hayes J, Pellegrini CA. Sole treatment of acid gastroesophageal reflux in idiopathic pulmonary fibrosis: a case series. Chest. 2006;129(3):794–800.CrossRefPubMedGoogle Scholar
  37. 37.
    Raghu G, Morrow E, Collins B, Ho L, Hinojosa M, Hayes J, et al. Laparoscopic anti-reflux surgery for idiopathic pulmonary fibrosis at a single center. Eur Respir J. 2016;48(3):826–32.CrossRefPubMedGoogle Scholar
  38. 38.
    Services UDoHaH. Organ Procurement and Transplantation Network. 2015. [Internet]. http://optntransplanthrsagov/coverage/latestdata/rptdataasp.Google Scholar
  39. 39.
    D’Ovidio F, Keshavjee S. Gastroesophageal reflux and lung transplantation. Dis Esophagus. 2006;19(5):315–20.CrossRefPubMedGoogle Scholar
  40. 40.
    Reid KR, McKenzie FN, Menkis AH, Novick RJ, Pflugfelder PW, Kostuk WJ, et al. Importance of chronic aspiration in recipients of heart-lung transplants. Lancet. 1990;336(8709):206–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Hadjiliadis D, Duane Davis R, Steele MP, Messier RH, Lau CL, Eubanks SS, et al. Gastroesophageal reflux disease in lung transplant recipients. Clin Transpl. 2003;17(4):363–8.CrossRefGoogle Scholar
  42. 42.
    Patti MG, Gasper WJ, Fisichella PM, Nipomnick I, Palazzo F. Gastroesophageal reflux disease and connective tissue disorders: pathophysiology and implications for treatment. J Gastrointest Surg. 2008;12(11):1900–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Zamost BJ, Hirschberg J, Ippoliti AF, Furst DE, Clements PJ, Weinstein WM. Esophagitis in scleroderma. Prevalence and risk factors. Gastroenterology. 1987;92(2):421–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Remy-Jardin M, Remy J, Wallaert B, Bataille D, Hatron PY. Pulmonary involvement in progressive systemic sclerosis: sequential evaluation with CT, pulmonary function tests, and bronchoalveolar lavage. Radiology. 1993;188(2):499–506.CrossRefPubMedGoogle Scholar
  45. 45.
    Gasper WJ, Sweet MP, Golden JA, Hoopes C, Leard LE, Kleinhenz ME, et al. Lung transplantation in patients with connective tissue disorders and esophageal dysmotility. Dis Esophagus. 2008;21(7):650–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Tseng D, Rizvi AZ, Fennerty MB, Jobe BA, Diggs BS, Sheppard BC, et al. Forty-eight-hour pH monitoring increases sensitivity in detecting abnormal esophageal acid exposure. J Gastrointest Surg. 2005;9(8):1043–1051–1052.CrossRefPubMedGoogle Scholar
  47. 47.
    Jobe BA, Richter JE, Hoppo T, Peters JH, Bell R, Dengler WC, et al. Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the esophageal diagnostic advisory panel. J Am Coll Surg. 2013;217(4):586–97.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Campos GMR, Peters JH, DeMeester TR, Öberg S, Crookes PF, Tan S, et al. Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg. 1999;3(3):292–300.CrossRefPubMedGoogle Scholar
  49. 49.
    Bredenoord AJ, Weusten BLAM, Timmer R, Conchillo JM, Smout AJPM. Addition of esophageal impedance monitoring to pH monitoring increases the yield of symptom association analysis in patients off PPI therapy. Am J Gastroenterol. 2006;101(3):453–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Hemmink GJM, Bredenoord AJ, Weusten BLAM, Monkelbaan JF, Timmer R, Smout AJ. Esophageal pH-impedance monitoring in patients with therapy-resistant reflux symptoms: “on” or “off” proton pump inhibitor? Am J Gastroenterol. 2008;103(10):2446–53.CrossRefPubMedGoogle Scholar
  51. 51.
    Patel A, Sayuk GS, Gyawali CP. Acid-based parameters on pH-impedance testing predict symptom improvement with medical management better than impedance parameters. Am J Gastroenterol. 2014;109(6):836–44.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Zerbib F, Roman S, Ropert A, des Varannes SB, Pouderoux P, Chaput U, et al. Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy. Am J Gastroenterol. 2006;101(9):1956–63.CrossRefPubMedGoogle Scholar
  53. 53.
    Pritchett JM, Aslam M, Slaughter JC, Ness RM, Garrett CG, Vaezi MF. Efficacy of esophageal impedance/pH monitoring in patients with refractory gastroesophageal reflux disease, on and off therapy. Clin Gastroenterol Hepatol. 2009;7(7):743–8.CrossRefPubMedGoogle Scholar
  54. 54.
    Patel A, Sayuk GS, Gyawali CP. Parameters on esophageal pH-impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2015;13(5):884–91.CrossRefPubMedGoogle Scholar
  55. 55.
    Zaninotto G, DeMeester TR, Schwizer W, Johansson K-E, Cheng S-C. The lower esophageal sphincter in health and disease. Am J Surg. 1988;155(1):104–11.CrossRefPubMedGoogle Scholar
  56. 56.
    Hill LD, Kozarek RA, Kraemer SJ, Aye RW, Mercer CD, Low DE, et al. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc. 1996;44(5):541–7.CrossRefPubMedGoogle Scholar
  57. 57.
    Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991;101(4 Pt 2 Suppl 53):1–78.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Spyridoulias A, Lillie S, Vyas A, Fowler SJ. Detecting laryngopharyngeal reflux in patients with upper airways symptoms: symptoms, signs or salivary pepsin? Respir Med. 2015;109(8):963–9.CrossRefPubMedGoogle Scholar
  59. 59.
    Reder NP, Davis CS, Kovacs EJ, Fisichella PM. The diagnostic value of gastroesophageal reflux disease (GERD) symptoms and detection of pepsin and bile acids in bronchoalveolar lavage fluid and exhaled breath condensate for identifying lung transplantation patients with GERD-induced aspiration. Surg Endosc. 2014;28(6):1794–800.CrossRefPubMedGoogle Scholar
  60. 60.
    Sereg-Bahar M, Jerin A, Jansa R, Stabuc B, Hocevar-Boltezar I. Pepsin and bile acids in saliva in patients with laryngopharyngeal reflux—a prospective comparative study. Clin Otolaryngol. 2015;40(3):234–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308–28; quiz 329.CrossRefPubMedGoogle Scholar
  62. 62.
    Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, et al. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135(4):1383–91, 1391–5.CrossRefPubMedGoogle Scholar
  63. 63.
    Finley K, Giannamore M, Bennett M, Hall L. Assessing the impact of lifestyle modification education on knowledge and behavior changes in gastroesophageal reflux disease patients on proton pump inhibitors. J Am Pharm Assoc. 2009;49(4):544–8.CrossRefGoogle Scholar
  64. 64.
    Ali T, Roberts DN, Tierney WM. Long-term safety concerns with proton pump inhibitors. Am J Med. 2009;122(10):896–903.CrossRefPubMedGoogle Scholar
  65. 65.
    Heidelbaugh JJ, Kim AH, Chang R, Walker PC. Overutilization of proton-pump inhibitors: what the clinician needs to know. Ther Adv Gastroenterol. 2012;5(4):219–32.CrossRefGoogle Scholar
  66. 66.
    Havu N. Enterochromaffin-like cell carcinoids of gastric mucosa in rats after life-long inhibition of gastric secretion. Digestion. 1986;35(Suppl 1):42–55.CrossRefPubMedGoogle Scholar
  67. 67.
    Jianu CS, Lange OJ, Viset T, Qvigstad G, Martinsen TC, Fougner R, et al. Gastric neuroendocrine carcinoma after long-term use of proton pump inhibitor. Scand J Gastroenterol. 2012;47(1):64–7.CrossRefPubMedGoogle Scholar
  68. 68.
    Cookson R, Flood C, Koo B, Mahon D, Rhodes M. Short-term cost effectiveness and long-term cost analysis comparing laparoscopic Nissen fundoplication with proton-pump inhibitor maintenance for gastro-oesophageal reflux disease. Br J Surg. 2005;92(6):700–6.CrossRefPubMedGoogle Scholar
  69. 69.
    Epstein D, Bojke L, Sculpher MJ, The REFLUX trial group. Laparoscopic fundoplication compared with medical management for gastro-oesophageal reflux disease: cost effectiveness study. BMJ. 2009;339(2):b2576.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, et al. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA. 2001;285(18):2331–8.CrossRefPubMedGoogle Scholar
  71. 71.
    Lundell L, Miettinen P, Myrvold HE, Hatlebakk JG, Wallin L, Malm A, et al. Seven-year follow-up of a randomized clinical trial comparing proton-pump inhibition with surgical therapy for reflux oesophagitis. Br J Surg. 2007;94(2):198–203.CrossRefPubMedGoogle Scholar
  72. 72.
    Lundell L, Miettinen P, Myrvold HE, Hatlebakk JG, Wallin L, Engström C, et al. Comparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis. Clin Gastroenterol Hepatol. 2009;7(12):1292–8.CrossRefPubMedGoogle Scholar
  73. 73.
    Dallemagne B, Weerts J, Markiewicz S, Dewandre J-M, Wahlen C, Monami B, et al. Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc. 2006;20(1):159–65.CrossRefPubMedGoogle Scholar
  74. 74.
    Oelschlager BK, Eubanks TR, Oleynikov D, Pope C, Pellegrini CA. Symptomatic and physiologic outcomes after operative treatment for extraesophageal reflux. Surg Endosc. 2002;16(7):1032–6.CrossRefPubMedGoogle Scholar
  75. 75.
    Kilic A, Shah AS, Merlo CA, Gourin CG, Lidor AO. Early outcomes of antireflux surgery for United States lung transplant recipients. Surg Endosc. 2013;27(5):1754–60.CrossRefPubMedGoogle Scholar
  76. 76.
    O’Halloran EK, Reynolds JD, Lau CL, Manson RJ, Davis RD, Palmer SM, et al. Laparoscopic Nissen fundoplication for treating reflux in lung transplant recipients. J Gastrointest Surg. 2004;8(1):132–7.CrossRefPubMedGoogle Scholar
  77. 77.
    Hoppo T, Jarido V, Pennathur A, et al. Antireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation. Arch Surg. 2011;146(9):1041–7.CrossRefPubMedGoogle Scholar
  78. 78.
    Oleynikov D, Eubanks TR, Oelschlager BK, Pellegrini CA. Total fundoplication is the operation of choice for patients with gastroesophageal reflux disease and defective peristalsis. Surg Endosc. 2002;16(6):909–13.CrossRefPubMedGoogle Scholar
  79. 79.
    Menezes MA, Herbella FAM, Patti MG. Laparoscopic antireflux surgery in patients with mixed connective tissue diseases. J Lap Adv Surg Tech. 2016;26(4):296–8.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Robert B. Yates
    • 1
  • Carlos A. Pellegrini
    • 2
  • Brant K. Oelschlager
    • 3
  1. 1.Department of SurgeryNorthwest Hospital and Medical Center, University of Washington MedicineSeattleUSA
  2. 2.Department of SurgeryUniversity of WashingtonSeattleUSA
  3. 3.Division of General Surgery, Department of SurgeryUniversity of Washington Medical CenterSeattleUSA

Personalised recommendations