Role and safety of fundoplication in esophageal disease and dysmotility syndromes.
Role and safety of fundoplication in esophageal disease and dysmotility syndromes. J Thorac Dis. 2019 Aug;11(Suppl 12):S1610-S1617 Authors: Bakhos CT, Petrov RV, Parkman HP, Malik Z, Abbas AE Abstract Gastroesophageal reflux disease (GERD) is quite prevalent worldwide, especially in the western hemisphere. The pathophysiology of GERD is complex, involving an incompetent esophagogastric junction (EGJ) as an anti-reflux barrier, as well as other co-morbid conditions such as gastroparesis, hiatal herniation or hyper acid secretion. Esophageal dysmotility is also frequently encountered in GERD, further contributing to the disease in the form of fragmented peristalsis, ineffective esophageal motility (IEM) or the more severe aperistalsis. The latter is quite common in systemic connective tissue disorders such as scleroderma. The main stay treatment of GERD is pharmacologic with proton pump inhibitors (PPI), with surgical fundoplication offered to patients who are not responsive to medications or would like to discontinue them for medical or other reasons. The presence of esophageal dysmotility that can worsen or create dysphagia can potentially influence the choice of fundoplication (partial or complete), or whether it is even possible. Most of the existing literature demonstrates that fundoplication may be safe in the setting of ineffective or weak peristalsis, and that post-operative dysphagia cannot be reliably predicted by pre-operative manometry parameter...
Condition: Gestational Diabetes Interventions: Other: Meal A; Other: Meal B Sponsor: Massachusetts General Hospital Not yet recruiting
Conditions: Nutrition; Physical Activity Interventions: Behavioral: Intervention Physical Activity; Other: Usual Care Sponsors: University of North Carolina, Chapel Hill; University of Texas Completed
Publication date: Available online 4 December 2019Source: Joint Bone SpineAuthor(s): Yannick Allanore
Gastrointestinal symptoms are common in both inflammatory and non-inflammatory connective tissue disorders and can involve any part of the gastrointestinal tract from the mouth to the anus. Dysphagia, gastrooesophageal reflux, nausea, vomiting, abdominal pain and change in bowel habit are common symptoms and usually arise from gastrointestinal dysmotility and altered visceral sensitivity. In scleroderma, sensorimotor dysfunction is pronounced and can result in complications such as Barrett's oesophagus, gastroparesis, small intestinal bacterial overgrowth, malabsorption and malnutrition, with an associated reduction in survival.
AbstractPurpose of ReviewConnective tissue disease-related interstitial lung disease (CTD-ILD) previously was a relative contraindication to lung transplantation primarily due to extra-pulmonary involvement of the disease. Recent published information focusing on the diagnosis and management of the extra-pulmonary complexities associated with CTD-ILD that challenge the success of lung transplantation indicate similar outcomes when compared to idiopathic causes of interstitial lung disease. Recent literature examining appropriate wait-listing criteria, disease management, and outcomes after lung transplantation are discusse...
ConclusionsLaparoscopic RYGB as an anti-reflux procedure is safe and may provide an alternative to fundoplication in the treatment of GERD for systemic sclerosis patients with esophageal dysmotility.
Conclusions: Minimally invasive fundoplication is both safe and effective in treating patients with severe GERD and concomitant esophageal hypomotility. Those with postoperative dysphagia are successfully managed by endoscopic treatments.
CONCLUSIONS: The presence and severity of gastroesophageal symptoms may not accurately reflect the seriousness of oesophageal involvement. GORD severity is associated with presence of restrictive lung pattern and pulmonary fibrosis. Oesophageal manometry and 24-hour pH study should be considered more frequently in the assessment of SSc patients. PMID: 26843456 [PubMed - as supplied by publisher]
Conclusions: We confirm an association between oesophageal dysmotility and respiratory symptoms in SSc-ILD. Larger numbers of patients followed up over time will need to be recruited to estimate the association between GORD measures and longitudinal changes in symptoms or severity of SSc-ILD.